Laparoscopic splenectomy as a definitive management option for high-grade traumatic splenic injury when non operative management is not feasible or failed: a 5-year experience from a level one trauma center with minimally invasive surgery expertise

Technique, indications and outcomes of laparoscopic splenectomy in stable trauma patients have not been well described yet. All hemodynamically non-compromised abdominal trauma patients who underwent splenectomy from 1/2013 to 12/2017 at our Level 1 trauma center were included. Demographic and clinical data were collected and analysed with per-protocol and an intention-to-treat comparison between open vs laparoscopic groups. 49 splenectomies were performed (16 laparoscopic, 33 open). Among the laparoscopic group, 81% were successfully completed laparoscopically. Laparoscopy was associated with a higher incidence of concomitant surgical procedures (p 0.016), longer operative times, but a significantly faster return of bowel function and oral diet without reoperations. No significant differences were demonstrated in morbidity, mortality, length of stay, or long-term complications, although laparoscopic had lower surgical site infection (0 vs 21%).The isolated splenic injury sub-analysis included 25 splenectomies,76% (19) open and 24% (6) laparoscopic and confirmed reduction in post-operative morbidity (40 vs 57%), blood transfusion (0 vs 48%), ICU admission (20 vs 57%) and overall LOS (7 vs 9 days) in the laparoscopic group. Laparoscopic splenectomy is a safe and effective technique for hemodynamically stable patients with splenic trauma and may represent an advantageous alternative to open splenectomy in terms of post-operative recovery and morbidit

Is the minimally invasive trauma surgeon the next (r)evolution of trauma surgery? Indications and outcomes of diagnostic and therapeutic trauma laparoscopy in a level 1 trauma centre

The aim of this study was to evaluate the trend in use, feasibility and safety of laparoscopy in a single level 1 European trauma centre. Laparoscopy in abdominal trauma is gaining acceptance as a diagnostic and a therapeutic tool as it reduces surgical invasiveness and may reduce post-operative morbidity. All trauma patients who underwent a laparoscopic procedure between January 2013 and December 2017 were retrospectively analysed. A sub-analysis of isolated abdominal trauma was also performed. There has been a significant increase in the use of this technique in the considered time period. A total of 40 patients were included in the study: 17 diagnostic laparoscopies and overall 32 therapeutic laparoscopies. Conversion rate was 15%. All patients were hemodynamically stable. The majority of patients were younger than 60 years, with an ASA score of I\u2013II and sustained a blunt trauma. Mean ISS score was 17. Colon and diaphragm were the most commonly laparoscopically diagnosed injuries, while splenectomy was the most common operation. The average operating time was 106 min. There were no missed injuries, no SSI, no re-interventions and no mortality related to the surgical procedure. The average length of stay was 14 days. No significant difference was found in the isolated abdominal trauma group. Laparoscopy is an emergent safe and effective technique for both diagnostic and therapeutic purposes in selected stable abdominal penetrating or blunt trauma patients. However, these results need to be put in relation with the level of the centre and the expertise of the surgeon