2018 Research Forum

The application of minimally invasive surgery for acute traumatic injuries: Outcomes at a Level II Trauma Center

Presenter & Principal Investigator: Jorge Almodovar MD Faculty Sponsor: Ruby Skinner MD FACS FCCP FCCM

Jorge Almodovar MD 1 , Ruby Skinner MD FACS FCCP FCCM 2 , Andrea Pakula MD MPH FACS 3 1 Resident Physician R4 2 Chief, Division of Trauma; Director, Surgical ICU; Chair, Institutional Review Board 3 Associate Director Surgical Critical Care; Director MIS/Robotics and Bariatric Surge ry

INTRODUCTION Minimally invasive surgery (MIS) is the standard approach for most of the surgical procedures performed by general surgeons. Traditionally the majority of operations for trauma are performed open due to the complexity of the cases, however, trauma surgeons are expanding their armamentarium to include MIS in a variety of acute procedures. We report our experience with the application of laparoscopy in a variety of trauma cases. PURPOSE To describe our experience with applying MIS for acute traumatic injuries. METHOD A retrospective review of trauma cases performed between 1/2012- 1/2016. During that time 52 laparoscopic cases were performed after traumatic injury. Patient demographics, injury severity (ISS), injury mechanisms, the types of procedures and outcomes will be described. Means and standard deviations were calculated and t test were performed. A p value of <0.05 was statistically significant. RESULTS Demographics- A total of 52 trauma cases were performed laparoscopically during the study period. The majority were male, n=43 and the age was 29 SD 11. Obesity was documented in 30%, hypertension or CAD was in 20%, and substance abuse was in 44%. Blunt trauma was in 35% and penetrating 65%. The ISS was 15 SD 9. Surgical Procedures- The majority, 85%, of the procedures were completed laparoscopically. Non- therapeutic laparoscopy was performed in 36%. Repair of diaphragmatic or traumatic abdominal wall hernias were 29%. Hematoma evacuation and control of bleeding was 15%. Control of solid organ bleeding and repair was performed in 11%. Intestinal repair occurred in 9%. For the cases that required open conversion ISS was 20 SD 7 vs. laparoscopic cases ISS was 12 SD 9, p=0.04. Outcomes- The overall length of stay was 5 days SD 6. There was n=1 late death in a poly-trauma patient that required open conversion for complex solid organ and intestinal injuries. There was n=1 case of a community acquired pneumonia, and n=1 case of a recurrent pneumothorax. CONCLUSIONS A descriptive series of trauma operations approached with MIS techniques is described. This cohort had high injury severity and a predominance of comorbid conditions. Laparoscopy was successfully applied in the majority of cases for a variety of therapeutic procedures and mortality and morbidity was low. MIS is safe and is gaining momentum for application in traumatic injury.

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