2003, Number 3
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ABSTRACTObjective: To review current practice of laparoscopy in the evaluation of patients with suspected thoracoabdominal trauma.
Data collection: Selective review of the literature (29 articles).
Data selection: The most relevant papers dealing with surgical endoscopy in trauma were selected.
Results: Evaluation of patients with suspected abdominal injury continues to challenge the trauma surgeon despite the availability of a variety of noninvasive and invasive diagnostic modalities. Unfortunately, none of the diagnostic tools currently available is a true stand-alone technique, and sound clinical judgment is required to formulate the optimal diagnostic approach for each patient. Frequently, more than one study is required to provide adequate evaluation of a patient with potential abdominal trauma. Laparoscopy has been used sporadically over the past 25 years in the evaluation of abdominal trauma. However, this technique became more widely used in the trauma setting only after the popularity of laparoscopic cholecystectomy made modern videoscopic equipment widely available. Laparoscopy has proved useful in determining the course of anterior abdominal gunshot and stab wounds. In many instances, the wound tracts found in these patients have been demonstrated to be extraperitoneal, and therefore patients were spared a nontherapeutic or negative laparotomy. Ivatury, Fabian, and others have documented laparoscopy as an excellent method for the evaluation of the diaphragm in hemodynamically stable patients who present with penetrating thoracoabdominal wounds. Experience with laparoscopic evaluation of blunt abdominal injury and with therapeutic laparoscopy in the trauma setting is more limited, but several innovative and promising techniques have recently appeared in the literature.
Conclusion: As laparoscopic technology continues to improve and as more trauma surgeons become skilled in videoscopic techniques, utilization of laparoscopy in the evaluation of truncal trauma is certain to increase.
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