Laparoscopy for Penetrating Trauma, Protocol to Avoid Missing Injuries during the Learning Curve

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Purpose: With recent advances in laparoscopic training, more evidence is being published that supports the safety of a laparoscopic approach in patients with penetrating trauma.However, the learning curve may still be long and associated with significant morbidity.This study aims to present the results obtained during the learning curve in patients with penetrating abdominal trauma undergoing laparoscopy after the implementation of a protocol in a level I trauma center. MethodsWe retrospectively reviewed the trauma registry of the southeast metropolitan health service from August 2017 -March 2020 and analyzed the patients that fullfiled the criteria for the laparoscopy for penetrating trauma protocol.Results: A total of 68 patients with penetrating trauma were initially treated with laparoscopy, 91% male.The most common mechanism of injury was stab wounds (n=56) and GSW (n=12), with a median ISS on admission of 9 (8-13).Within the laparoscopies performed, 86% (n=59) were positive diagnostic laparoscopies and 48 of them were therapeutic.Ten patients (14%) required conversion to laparotomy, the most frequent cause being uncontrolled hemoperitoneum (n = 4).It is observed in the learning curve less conversion to open surgery with the implementation step.This series did not have any missed injuries, operative morbidity, or mortality.Conclusions: Laparosocopic is a plausible approach for the diagnosis and treatment of penetrating abdominal injuries in hemodynamically stable patients during the learning curve.Proper selection of patients and the use of a standarized protocol are the main factors for the application of this technique

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