Trauma laparoscopy from 1925 to 2017: Publication history and study demographics of an evolving modality

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The diagnosis of traumatic injuries has undergone sweeping changes in the last century. Various diagnostic modalities have been introduced and tested, including diagnostic peritoneal lavage, local wound exploration, abdominal ultrasound (FAST), and computed tomography. Despite the variety of options, exploratory laparotomy has been the traditional approach to surgical management of many trauma patients. This intervention is known to have a significant nontherapeutic laparotomy rate1 with a high procedure-related morbidity and mortality rates.2,3 Treatment alternatives, including a growing practice of nonoperative management in select trauma patients, have thus been sought over the last century.
Dr. A. Rendle Short first described exploratory “coelioscopy” for trauma patients in 1925,4 and the practice of laparoscopy in a trauma population continued to surface in the literature during the following decades. The 1980s were the founding years for laparoscopy in general surgery, and the end of that decade marked an increase in publications about the use of laparoscopy in trauma. Since that time, advances in instrumentation, technology, and laparoscopic techniques have allowed laparoscopy to become more common in the realm of trauma surgery.
Trauma laparoscopy, when used in select trauma patients, has been shown to reduce morbidity and postoperative pain, decrease overall cost and length of hospital stay, and allow for earlier return to work.5,6 However, risks involved with the use of trauma laparoscopy include delay to definitive treatment, complications related to pneumoperitoneum, and missed injuries, especially when considering hollow viscus injury.1,7 Laparoscopy is contraindicated in hemodynamically unstable patients, in patients with traumatic brain injury due to the effects of pneumoperitoneum on intracranial pressure, or in settings without immediate equipment availability and surgeon expertise.
Despite these limitations, there is a large and growing body of literature that addresses trauma laparoscopy. A true consensus among trauma providers regarding its use has yet to be reached, especially as the role of laparoscopy continues to evolve.1 The goal of this review was to unify our knowledge of laparoscopy in trauma. By identifying the publication history on the topic, we sought to identify trends and analyze study demographics. We also chose to describe ten landmark papers on the topic, in an attempt to summarize almost one hundred years of publications.

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