Emergency laparoscopic procedures.

Abstract

Emergency laparoscopic procedures (ELPs) have been performed since the 1960s. It never caught on due to limitations inherent in the actual procedure. Technological innovations notably in camera, electronic insufflators and light systems were key to the rebirth of laparoscopy in the late 1980s. This was mostly confined to elective indications where its benefits were most obvious. With increasing experience, the benefits of minimally access surgery (MAS) are being applied to emergency indications such as evaluation of peritonitis and abdominal pain, appendectomy, repair of perforated ulcers and other acute conditions. ELP offers good training for surgeons but requires a trained laparoscopist to perform more complicated procedures. As there is not much time for thorough patient evaluation, patient selection and resuscitation are key to safe ELP. It should be done the same way as in open surgery; the difference is in the access. Visibility and technical difficulties are more likely and where further progress is limited or patient's condition changes, then early conversion is wise. Conversion rate in ELP is higher and the tolerance level for this should be much lower than in elective circumstances. However, the benefits of ELPs can be seen in decreased wound and other complications, and earlier mobilisation. Hospitalisation is not very much shorter in most instances as managing the disease process itself requires this. With time, more emergency procedures will be done laparoscopically for demand and knowledge will increase as patients and surgeons become familiar with MAS.