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Although Bozzini had coined the term “lichteiter” or “light conductor” to refer to his candle-powered endoscope in 1806, it was an instrument that was never tested in humans.1 The first procedures in humans were performed by urologists to visualize the urethra and bladder. It was the gynecologists, however, who pioneered many of the early intraperitoneal procedures.2 The development of laparoscopy closely parallels the advances in technology. Early instrumentation was crude, and the heat that was created as a byproduct of light production significantly limited utility. The advent of new devices and techniques allowed for the rediscovery of endoscopic and laparoscopic procedures in adults; however, the size of the instruments continued to prevent translation of many of these advances to the pediatric population. The 1959 introduction of Harold Hopkins’ rod-lens system coupled with Karl Storz’s fiber optic cold light illumination in 1960 allowed a combination of a miniature lens system with a nonheat-generating light source, and provided the foundations of modern pediatric endoscopic and laparoscopic techniques.3. (5) Diagnostic laparoscopy (DL) is minimally invasive surgery for the diagnosis of intraabdominal diseases. The procedure enables direct inspection of large surface areas of intraabdominal organs; facilitates the acquisition of biopsy specimens, cultures, and aspirates; allows the use of laparoscopic ultrasound; and makes therapeutic intervention possible. Diagnostic laparoscopy has been applied to many clinical situations with variable success.(1) Diagnostic laparoscopy has been proposed for trauma patients with suspected intraabdominal injuries in an attempt to reduce the rate of nontherapeutic laparotomies with their associated morbidity and cost. Indications for DL include suspected intraabdominal injury despite a negative initial workup after blunt trauma, abdominal stab wounds with proven or equivocal penetration of fascia, abdominal gunshot wounds with doubtful intraperitoneal trajectory, diagnosis of diaphragmatic injury from penetrating trauma to the thoracoabdominal area, and creation of a transdiaphragmatic pericardial window to rule out cardiac injury. Absolute contraindications for DL include hemodynamic instability due to hemorrhagic shock or evisceration. Relative contraindications include peritonitis, known or obvious intraabdominal injury or posterior penetrating trauma with a high likelihood of bowel injury, and lack of expertise and equipment. Surgeons with appropriate training and experience working at institutions with appropriate support may find benefit with the use of DL in the trauma
the number of missed injuries is consistently reported to be less than 1% (levels 2 and 3 evidence) [16–22]. air leaks through these wounds should be controlled with sutures. In 2007. For penetrating trauma. often followed by laparoscopic treatment of the detected abdominal disorder. Many studies have documented the feasibility and safety of DL for the aforementioned patient population (levels 1– 3 evidence) [15–39]. Usually. performed by our . Weinberg et al. the pneumoperitoneum is created through a periumbilical incision using a Veress needle or the open Hasson technique after insertion of a nasogastric tube and a Foley catheter for visceral decompression. peritoneal violation can be reliably determined. (1) Emergency laparoscopy is widely used to identify the causative pathology of acute abdominal pain. local anesthesia with intravenous sedation has also been used successfully and may facilitate the use of DL in the emergency department.setting. specificity. Special attention should be given to the possibility of a tension pneumothorax caused by the pneumoperitoneum in the setting of unsuspected diaphragmatic rupture. However. However. respectively. to indicate early conversion to open exploration with the first encounter of a positive finding such as the identification of peritoneal penetration in penetrating trauma or active bleeding/peritoneal fluid in blunt trauma patients). The peritoneal cavity is examined systematically. When DL has been used as a screening tool (i. pressures up to 15 mmHg have been described without untoward events. In the case of penetrating wounds. The colon can be mobilized and the lesser sac inspected. The sensitivity. Suction/irrigation may be needed for optimal visualization.. and additional trocars are used for organ manipulation. The procedure usually is performed with the patient under general anesthesia. and diagnostic accuracy of DL used to predict the need for laparotomy are high (75% to 100%) (levels 1–3 evidence) [15–39] but depend on several factors. A 308 laparoscope is advantageous. In the sequence of a series of a previous consensus development conferences. and methylene blue can be administered intravenously or via a nasogastric tube to assist in identifying urologic or gastric injuries. Many authors have used low insufflation pressures (8–12 mmHg) to minimize unwanted side effects of the pneumoperitoneum.  demonstrated the safety and highlighted the advantages of ‘‘awake laparoscopy’’ with the patient under local anesthesia in the emergency department over DL in the operating room (level 3 evidence).e. with patient positioning maneuvers used to advantage.
On the other hand laparoscopy offers a superior overview of the abdominal cavity with minimal trauma. Although the benefits of laparoscopy are appealing in the trauma population. increasingly complex procedures are being undertaken with this minimally invasive method. and diagnostic laparoscopy. They stated that all recommendations given are valid only for surgeons or surgical teams with sufficient expertise in laparoscopic surgery. Sufficient expertise however. Emergency laparoscopy competes with the initial usage of other diagnostic procedures and imaging and additionally carries the risk of procedure-related complications especially in emergency situations. The guidelines on laparoscopy for abdominal emergencies include the available evidence in this heterogeneous field. acute cholecystitis with the recommendation to carry out surgery as early as possible (< 48 hrs). that in most of the studies in which hospital stay and convalescence were utilised as endpoints may merely reflect traditions of postoperative care and patient expectations associated with open procedures rather than differences between open and laparoscopic surgical techniques(2) Laparoscopy has become commonplace in general surgical practice. Clinical practice guidelines recommendations should be based on good scientific evidence from controlled clinical trials. Grade A recommendations (highest grade) for performing emergency laparoscopy and treatment are given for patients with a presumable diagnosis of perforated peptic ulcer. gastroesophageal reflux procedures. delay to define open surgical treatment and missing diagnosis. but also in perforated cases and in a variety of suspected gynaecological disorders. is not defined although it is the most crucial factor to be taken into account. and as technique and instrumentation continue to improve. Although highly recommended we should be aware of the fact. always convertible to open surgery. which subgroups of patients should undergo laparoscopic instead of open surgery for acute abdominal pain . The responsible group of experts from different disciplines followed a transparent protocol with using a nominal group process for reaching consensus. and recovery time.group under the mandate of the European Association for Endoscopic Surgery (EAES) since 1993 the most recent one (in 2005) aimed to develop guidelines to define. The goal of laparoscopic surgery is to provide equal or superior visualization compared with open procedures but with less patient morbidity. acute appendicitis with treatment only if diagnosis is confirmed. including cholecystectomy. postoperative discomfort. the complexity and potential hemodynamic instability associated with intraabdominal . This goal has clearly been met with a number of laparoscopic procedures.
2 and advances in technology have resulted in multiple reevaluations of this technique. the majority of reports in the literature are single patient experiences or small case series. large randomized prospective trials comparing open and laparoscopic evaluation for the treatment of trauma patients do not exist. it remains a technique in evolution for the evaluation and treatment of trauma. Unfortunately. To date. In the 1970s. (6) . Although many groups believe that diagnostic laparoscopy has decreased the negative trauma laparotomy rate. laparoscopy was reported for use as part of the diagnostic armamentarium for abdominal trauma1. Although laparoscopy has been used in general surgery for several decades.injury usually preclude the use of this modality. Carefully selected trauma patients may benefit from this emerging technology.1-6 this remains to be conclusively proven.
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