Till date it is a common practice to do open and extensive surgery for even simple abdominal and thoracic trauma due to unavailability of in-house advance diagnostic tools, various types of Blood Products, experienced surgeon & anesthetist and appropriate trauma management kits etc.
Minimally invasive surgery has become a viable alternative to conventional surgery in poly trauma cases. The technical advantages of minimally invasive surgery can be translated into clinical benefits for the patients, i.e., less postoperative pain and impairment of lung function, better cosmetic results, shorter hospitalization, and earlier convalescence. Laparoscopic operations have replaced a significant proportion of open surgical procedures and are now routinely used for trauma injuries.
Some minimally invasive surgical procedures are now successful in the following cases:-
1. Blunt Abdominal Trauma with haemoperitoneum. – Spleen, Liver, Stomach, pancreas, Retro-peritoneal structure.
2. Penetrating Abdominal tumor
3. Thoracoscopy and injury to lung, peritoneum, mediastinal and Diaphragmatic injury.
The most established role for laparoscopy in trauma is for the diagnosis of abdominal injuries. It may be the best diagnostic test available to assess peritoneal penetration from questionable knife or gunshot wounds. Laparoscopy is the most reliable diagnostic technique to identify, and in many cases repair, diaphragmatic injuries. Specific injuries to solid organs like Liver and Spleen and viscera can be accurately identified to determine the need of actual repair. Laparoscopic screening and diagnosis allows for more accurate use of open laparotomy when significant injuries are identified, thus avoiding the morbidity associated with nontherapeutic laparotomy. Therapeutic applications continue to be limited to repair of minor injuries to the visceral structures and solid organs. It is not only more cosmetic, but also more importantly may have the advantage of better access to all areas of the abdominal compartment over standard techniques. Complex injuries occasionally may be undertaken in the stable patient with the application of hand-assisted laparoscopy, minilaparotomy, or angiographic embolization.
It is important to emphasize the unpredictable and potentially unstable nature of traumatic injuries. The surgeon must always be prepared to rapidly open the abdomen to gain control of hemorrhage.
While the role of laparoscopic surgery has been generally accepted for the management of benign disorders, there is ongoing debate regarding the adequacy of this technique in surgical oncology. There is evidence that minimally invasive surgery can reduce perioperative morbidity in cancer patients.