SEARCH · PubMed Health

Results for “laparoscopy”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 577 records · Page 32Linked to original sources

PubMed2006

[Laparoscopy for abdominal trauma].

With increasing experience in minimally invasive surgery, laparoscopy's role in abdominal trauma can be defined exactly. Main exclusion criteria are hemodynamic instability and increased intracranial pressure. A literature review of 1996 to 2006 reveals perforating injury mainly of the left thoracoadominal area as the most important indication for laparoscopy . Its goal is to determine intraperitoneal lesions and integrity of the abdominal wall and diaphragm. Minor injuries of the parenchymatous organs and diaphragm can be successfully repaired laparoscopically. In blunt abdominal trauma, laparoscopy is used as a complementary diagnostic device in case ultrasound and multislice CT show unclear findings and the patient's clinical status requires invasive measures. The clear weakness of laparoscopy in abdominal trauma is its inability to identify reliably hollow viscus perforation and retroperitoneal injury. In this, sensitivity is only 25%. In case of proven lesions of the gastrointestinal tract, conversion to laparotomy is to be considered. Despite the reports on laparoscopic treatment, open repair of hollow organ injuries is still to be recommended.

Abdominal Injuries↗

PubMed2002

[Results of comprehensive data collection concerning urologic laparoscopy].

To evaluate the current status of laparoscopy, the "Working Group Laparoscopy" of the German Urological Association performed a questionnaire among urologists in Germany. Of 300 questionnaires 183 were returned and analyzed (61%): 54% of the departments already performed laparoscopy and another 50% are planning to introduce this technique. The major concerns are economical (70%), long learning curve (92%), investment (53%), and lack of scientific data (76%). Simple nephrectomy, cryptorchism, and varicoceles are treated by 66, 59, and 58 of the 96 departments laparoscopically (of 183 resp.). Laparoscopic surgery for radical prostatectomy and tumor nephrectomy is done by 32 and 34 of 96 departments. Only a minority of the centers performs more than 40 laparoscopies per year and indication. Compared to a survey conducted in 1995, the acceptance level of this technique has increased (100% vs 48%). Only a minority of the departments performs more than 40 laparoscopic interventions per year for one indication.

Attitude of Health Personnel↗

PubMed2003

Laparoscopy-assisted repair of diaphragm injuries.

In this study we review our experience with an alternative laparoscopy-assisted technique for repair of diaphragm injuries. All patients admitted with an isolated diaphragm injury who underwent laparoscopy-assisted repair between January 1996 and February 2000 were included in the study. The diagnosis of the diaphragm injury was either obvious, with omentum herniating through the chest wall, or occult with confirmation of the injury at laparoscopy. Repair of the diaphragm was performed using standard surgical instruments via a 4-cm subcostal incision with use of abdominal wall traction and the laparoscope for visualization of the defect. A total of 24 patients underwent successful laparoscopy-assisted repair; There were twenty men and four women with an average age of 28.8 years (range 23-49 years). The average Revised Trauma score was 12. There were 23 grade II and 2 grade III diaphragm injuries. The mean operative time was 61 minutes (range 25-120 minutes) and the average hospital stay from the time of surgery to the time of discharge was 2.29 days (range 1-4 days). The procedure failed in one patient as a result of gaseous distension of the bowel. One patient developed a tension pneumothorax, and two others developed atelectasis. Laparoscopic-assisted repair of isolated diaphragm injuries using abdominal wall traction and standard surgical instruments is a feasible option with minimal morbidity and no mortality.

Adult↗

PubMed2000

Influence of gases on intraperitoneal immunity during laparoscopy in tumor-bearing rats.

Laparoscopy has been associated with metastases to abdominal wall wounds. In addition, many recent experimental studies suggest that laparoscopy is associated with increased tumor dissemination. It is possible that immune or metabolic disturbances due to the use of a pneumoperitoneum could contribute to this problem. To investigate this possibility, we studied the effect of two insufflation gases and gasless laparoscopy on in vivo peritoneal macrophage function and intraperitoneal pH in an experimental model. A carcinoma was implanted into the flank of 32 experimental rats that underwent laparoscopic surgery in one of four treatment groups: anesthesia alone, gasless laparoscopy, helium insufflation, and CO2 insufflation. Intraperitoneal pH was monitored during surgery, and peritoneal macrophage function was determined 3 days after surgery by harvesting peritoneal macrophages and then examining their ability to produce tumour necrosis factor-alpha (TNF-alpha). CO2 insufflation was associated with a consistent fall in intraperitoneal pH and a significant reduction in TNFalpha production. These findings did not occur in the other study groups. The results of this study demonstrate that CO2 insufflation results in depressed intraperitoneal macrophage activity. It is possible that it is mediated by pH changes. In addition, it could be a contributing factor to the development of port-site metastases. Further studies are needed to determine whether the factors identified act during clinical surgery.

Animals↗

PubMed1998

Origin of laparoscopy: coincidence or surgical interdisciplinary thought?

The history of laparoscopy illustrates the interaction between the many areas of medicine and technology; in fact, the development of that technique is a cumulative effort of internists, gynecologists, and surgeons. At the beginning of our century, however, neither group was particularly open to the idea of scholarly exchange. In this respect, an early pioneer of laparoscopy, Georg Kelling (1866-1945) of Dresden and the story surrounding the invention of the laparoscopy are interesting exceptions. Although Kelling regarded himself a surgeon, he devoted a great deal of energy to the development of "nonsurgical" methods of treatment. He spent a great part of his life determining stomach capacity, constructing a semiflexible tube endoscope (straightened after the insertion), and attempting to alleviate gastrointestinal bleeding by means of high-pressure pneumoperitoneum (lufttamponade). To observe the effects of insufflation on abdominal organs, Kelling introduced a cystoscope into the abdominal cavity. In fact, the invention of "celioscopy" or laparoscopy (1901) can be called a synthesis of Kelling's work with insufflation and his fascination with endoscopy.

Germany↗

PubMed1999

Laparoscopy and laparoscopic ultrasonography for staging pancreatic cancer: critical appraisal.

A pilot study was designed to elucidate the role of staging laparoscopy for determining resectability in patients with pancreatic cancer. The additional value of laparoscopic contact ultrasonography (LCU) was also evaluated with specific regard to its ability to detect hepatic metastases and assess vascular infiltration of the portomesenteric trunk. A consecutive sample of 50 patients referred for operation of a suspected pancreatic cancer were submitted to preoperative contrast-enhanced high-resolution computed tomography (CT) and staging laparoscopy combined with LCU at a university hospital. For those progressing to exploratory laparotomy, the intraoperative findings relating to tumor diffusion and vascular infiltration were compared to CT, laparoscopic, and LCU data. Analytical description of the laparoscopic findings is given. Row data of predicted versus observed vascular infiltration were tabulated for CT and LCU. The sensitivity, specificity, and overall accuracy of each diagnostic test were calculated for comparative analysis. Laparoscopy alone prevented unnecessary laparotomy in 20% of cases. A complete procedure could not be achieved in 28% of patients. Three false-negative staging results occurred. LCU identified small (benign) hepatic nodules not seen by CT in 8% of patients. Sensitivity, specificity, and overall accuracy for assessing vascular infiltration were 82%, 53%, and 69% for CT and 94%, 80%, and 87% for LCU. Laparoscopy was confirmed to be safe and effective for staging pancreatic cancer. Because of its unique capabilities to detect even small peritoneal tumor deposits a quick exploration immediately before laparotomy is advised in all patients. The additional benefit of a more extensive procedure is not supported by our results. Although LCU appears to define the vascular involvement more accurately than conventional CT, the limitation of getting clinically useful ultrasound data in all the patients suggests its adoption in only a selected population.

Adult↗

PubMed2005

Urogenital nonunion--the case for laparoscopy for the impalpable testis.

A case of urogenital nonunion is presented to illustrate the importance of laparoscopy for the impalpable testis. A 4-year-old boy with an impalpable left testis underwent laparoscopy. This revealed not only the vas deferens entering the deep inguinal ring but also a small intraabdominal testis supplied by the testicular vessels. Exploration of the inguinal canal revealed the vas deferens terminating in a nubbin of tissue. Histology identified epididymal structures both adjacent to the testis and in the terminal nubbin of the vas deferens. This is an example of urogenital nonunion. Complete separation of the vas and testis with epididymal structures attached to each is very unusual, with only four other cases reported. Laparoscopy should be the initial procedure for impalpable testis. A blind-ending vas deferens found on exploration of the inguinal canal might be taken as evidence of the vanishing testis syndrome. However, this conclusion should not be drawn unless laparoscopy has demonstrated testicular vessels entering the internal inguinal ring.

Child, Preschool↗

PubMed2005

Diagnostic laparoscopy-assisted cholangiography in infants with prolonged jaundice.

Cholangiography is often crucial for establishing the definitive cause of neonatal jaundice. We present our protocol for using laparoscopy-assisted cholangiography in infants with prolonged jaundice and discuss its benefits. Firstly, a 5 mm supra-umbilical trocar is introduced to create a port for a 0 degrees laparoscope. A 5 mm trocar is then inserted through a right subcostal incision to allow the liver and gallbladder to be visualized. If the gallbladder is of good size, the fundus is exteriorized through the right subcostal trocar site and a catheter is inserted into the gallbladder for cholangiography. If the gallbladder is atretic, the fundus is not exteriorized and a laparotomy is performed for open intraoperative cholangiography because the lumen of an atretic gallbladder is usually not fully patent and cholangiography through its exteriorized fundus often fails. We reviewed 18 jaundiced infants thought to have biliary atresia (BA) who had laparoscopy-assisted cholangiography. At laparoscopy, four patients had good sized gallbladders and minimal to mild liver fibrosis. They underwent cholangiography via the exteriorized fundus, and BA in two cases and biliary hypoplasia in two cases were identified. The remaining 14 had atretic gallbladders and varying degrees of liver fibrosis. Cholangiography via the exteriorized fundus was performed in one patient, but failed and converted to open cholangiography. Open intraoperative cholangiography identified BA in all 14 cases. All BA cases progressed to Kasai portoenterostomy directly after diagnosis. Laparoscopy is used to determine the type of cholangiography to be performed based on the appearance of the gallbladder and this simple, accurate, and safe protocol allows the anatomical structure of the biliary tree to be obtained accurately with minimal surgical intervention.

Bile Ducts↗

PubMed1996

A study of second-look laparoscopy after acute salpingitis.

Acute salpingitis (AS) has a major impact on the reproductive health of women. In this study second-look laparoscopy was assessed for its ability to predict reproductive function after AS. We questioned 158 women who had had a second-look laparoscopy with tubal dye insufflation after laparoscopically proven AS between September 1984 and August 1989. The answers of 69 women with at least two years of involuntary infertility were analyzed. The mean follow-up period was 76 months (range 53-108 months). Second-look laparoscopy revealed bilateral tubal occlusion in 21.7% (15/69). Bilateral tubal occlusion was found in 9.5% (2/21) after mild stage, 20% (4/20) after moderate stage and 32.1% (9/28) after severe stage AS. The rate of infertility during follow-up was 9.5% (stage I), 35% (stage II) and 39.9% (stage III). Eighty per cent (12/15) of women with proven bilateral tubal occlusion after treated AS had involuntary infertility, and 14.8% (8/54; P = 0.000001) of women with one or both tubes patent also had infertility. Specificity, sensitivity and positive predictive value for subsequent infertility were 85.2%, 80% and 84.1%, respectively. Pelvic adhesions (21/69) were strongly correlated with bilateral tubal occlusion (8/21; 38.1%; P = 0.029), a history of chronic pelvic pain (14/21; 66.7%; P = 0.00024), as well as failure to achieve an intrauterine pregnancy (10/21; 47.6%; P = 0.024). Recurrent pelvic infections occurred in 16% (12/69) and ectopic pregnancies in 7.3% (5/69). Operations for infertility and pelvic pain (excluding ectopic pregnancy), were carried out in 11.6% (8/69). We conclude that second-look laparoscopy after treated AS have accurate evaluation of reproductive function.

Acute Disease↗

PubMed2002

The efficacy of laparoscopy in detecting and treating associated congenital malformations in children.

One of the main advantages of laparoscopy in children is the fact that it enables a magnified view and the possibility to explore the whole abdominal cavity. This case report clearly shows these advantages. We report the case of a 3-yr-old girl, suffering from severe GERD and right inguinal inguinal hernia, who had already been operated at birth for esophageal atresia. We performed a laparoscopic fundoplication according to Nissen and, at the end of procedure, we decided to turn the optic down to control the right inguinal region to confirm the presence of an inguinal hernia. To our great surprise we found a right oblique external hernia as well as a direct inguinal hernia on the same side. Both hernias was treated successfully in laparoscopy. At a 1-year follow-up, the patient presented no reflux and no recurrence of the inguinal hernias. The laparoscopy in this case permitted operation on two different pathologies involving the upper and lower parts of the abdominal cavity using the same ports and without enlarging the incision, as would happen in laparotomy. The main relevance of this case is that laparoscopy allowed the detection of an associated pathology like a direct inguinal hernia that would have been certainly overlooked in open surgery and could have caused a recurrent hernia if operated via open surgery.

Child, Preschool↗

PubMed2003

Diagnostic laparoscopy.

Diagnostic laparoscopy began in a surgical unit in a developing country in 1972. The developers of this technique aimed to hasten diagnosis, reduce patient distress, and improve bed utilization in an overcrowded teaching hospital wherein simple investigations such as x-rays took weeks to materialize. Over a period of 18 years reaching to 1990, 3,200 diagnostic laparoscopies were performed on adults under local anesthesia with no mortality, a complication rate of 0.09%, an 84% diagnosis rate, and 74% undergoing histologic biopsies targeting a wide spectrum of pathology. The equipment cost spread out over the 3,200 patients works out to 30 rupees (0.60 dollar) per patient. With the availability of noninvasive diagnostic aids such as ultrasound, computed tomography, and magnetic resonance imaging used US, CT, MRI under the control of target biopsy, the role of diagnostic laparoscopy has altered. Since 1990, clinicians have had the sophistication of the video camera and the pneumoperitoneum insufflator. Diagnostic laparoscopy is used for the evaluation of liver and peritoneal pathology, abdominal tuberculosis, malignancy, acute abdomen, and abdominal trauma. It often is a prelude to laparoscopic treatment of the underlying pathology, specifically in cases of acute appendicitis.

Abdomen, Acute↗

PubMed2003

Immunologic postoperative competence after laparoscopy versus laparotomy.

BACKGROUND: Sepsis is a major complication associated with increased morbidity and mortality in patients treated surgically for hepatobiliary and colorectal diseases. Impairment of immune function after surgery may be one of the mechanisms causing increased susceptibility to infection. From November 1999 to October 2001, the perioperative and postoperative immune responses of 20 patients who underwent laparoscopy were compared with those of 20 patients who underwent laparotomy. All the patients were affected by benign pathologies. The current study aimed to elucidate the differences between the immune responses induced by the two different surgical approaches. METHODS: Immunologic function was assessed by a count of lymphocyte subsets (CD3, CD4, CD8, CD3-HLA-DR, CD19, CD16, CD57) and monocytes expressing human leukocyte antigen DR (HLA-DR). Blood samples were obtained 1 day before the surgical therapy, then 2 and 8 days after therapy. For statistical analysis, the continuous variables were compared using Student's t-test. Probability values less than 0.05 were considered significant. RESULTS: With regard to T-lymphocyte function, a fall 2 days after surgery was assessed for both laparoscopy (p < 0.0005) and laparotomy (p < 0.00003) groups. At 8 days after surgery, these values had returned to the preoperative level on both groups. The activity of B-cells and natural killer cells was not significantly affected, whereas the number of monocytes expressing HLA-DR showed a long-lasting decrease after laparotomy (p < 0.011 2 days after surgery and p < 0.02 8 days after surgery), but not after laparoscopy. CONCLUSION: Impairment of cell-mediated immune function after surgery was demonstrated especially in patients treated by laparotomy, as compared with those treated by laparoscopy.

Aged↗

PubMed2003

Rasmussen's model of human behavior in laparoscopy training.

AIMS: Compared to aviation, where virtual reality (VR) training has been standardized and simulators have proven their benefits, the objectives, needs, and means of VR training in minimally invasive surgery (MIS) still have to be established. The aim of the study presented is to introduce Rasmussen's model of human behavior as a practical framework for the definition of the training objectives, needs, and means in MIS. METHODS: Rasmussen distinguishes three levels of human behavior: skill-, rule-, and knowledge-based behaviour. The training needs of a laparoscopic novice can be determined by identifying the specific skill-, rule-, and knowledge-based behavior that is required for performing safe laparoscopy. Future objectives of VR laparoscopy trainers should address all three levels of behavior. RESULTS: Although most commercially available simulators for laparoscopy aim at training skill-based behavior, especially the training of knowledge-based behavior during complications in surgery will improve safety levels. However, the cost and complexity of a training means increases when the training objectives proceed from the training of skill-based behavior to the training of complex knowledge-based behavior. CONCLUSION: In aviation, human behavior models have been used successfully to integrate the training of skill-, rule-, and knowledge-based behavior in a full flight simulator. Understanding surgeon behavior is one of the first steps towards a future full-scale laparoscopy simulator.

Algorithms↗

PubMed2004

Peritoneal pH during laparoscopy is dependent on ambient gas environment: helium and nitrous oxide do not cause peritoneal acidosis.

BACKGROUND: Little is know about the effects of different insufflation gases on peritoneal pH during laparoscopy. However, these changes may influence the intracellular signalling system, resulting in altered cell growth or adhesiveness. The aim of this study was to determine the effects of carbon dioxide (CO(2)), nitrous oxide (N(2)O), and helium (He) on parietal and visceral peritoneal pH. The effect of different intraabdominal pressures on parietal and visceral peritoneal pH was also examined. METHODS: We conducted both an ambient gas study and a pressure study. For the ambient gas study, 20 pigs were divided into the following four groups: (a) CO(2), (b) He, (c) N(2)O, and (d) abdominal wall lift (Lift) laparoscopy. Parietal and visceral peritoneal pH were measured at 15 min intervals for 180 min. For the pressure study, 15 pigs were divided into the following three groups: (a) CO(2), (b) He, (c) N(2)O laparoscopy. Baseline values were established for parietal and visceral peritoneal pH. Intraabdominal pressure was then increased stepwise at 1-mmHg intervals to 15 mmHg. After pressure was maintained for 15 min at each setting, parietal and visceral peritoneal pH were measured. RESULTS: Ambient gas environment was the major determinant of parietal peritoneal pH. Carbon dioxide caused parietal peritoneal acidosis. Helium, N(2)O, and Lift caused alkalotic parietal peritoneal pH. Intraabdominal pressure had a minor effect on parietal peritoneal pH. At higher intraabdominal pressure (12-15 vs 5-8 mmHg), CO(2) caused a slight decrease in parietal peritoneal pH, whereas N(2)O and He caused a slight increase in parietal peritoneal pH. Visceral peritoneal pH remained relatively unaffected during all studies. CONCLUSIONS: Parietal peritoneal pH during laparoscopy was highly dependent on the ambient gas environment. The effect of intraabdominal pressure on parietal peritoneal pH was of minor significance. Carbon dioxide caused a slight worsening of parietal peritoneal acidosis at higher intraabdominal pressure, whereas, N(2)O, He, and Lift did not cause parietal peritoneal acidosis.

Animals↗

PubMed2005

Laparoscopy for abdominal emergencies: evidence-based guidelines of the European Association for Endoscopic Surgery.

BACKGROUND: Emergency laparoscopic exploration can be used to identify the causative pathology of acute abdominal pain. Laparoscopic surgery also allows treatment of many intraabdominal disorders. This report was prepared to describe the effectiveness of laparoscopic surgery compared to laparotomy or nonoperative treatment. METHODS: A panel of European experts in abdominal and gynecological surgery was assembled and participated in a consensus conference using Delphi methods. The aim was to develop evidence-based recommendations for the most common diseases that may cause acute abdominal pain. RECOMMENDATIONS: Laparoscopic surgery was found to be clearly superior for patients with a presumable diagnosis of perforated peptic ulcer, acute cholecystitis, appendicitis, or pelvic inflammatory disease. In the emergency setting, laparoscopy is of unclear or limited value if adhesive bowel obstruction, acute diverticulitis, nonbiliary pancreatitis, hernia incarceration, or mesenteric ischemia are suspected. In stable patients with acute abdominal pain, noninvasive diagnostics should be fully exhausted before considering explorative surgery. However, diagnostic laparoscopy may be useful if no diagnosis can be found by conventional diagnostics. More clinical data are needed on the use of laparoscopy after blunt or penetrating trauma of the abdomen. CONCLUSIONS: Due to diagnostic and therapeutic advantages, laparoscopic surgery is useful for the majority of conditions underlying acute abdominal pain, but noninvasive diagnostic aids should be exhausted first. Depending on symptom severity, laparoscopy should be advocated if routine diagnostic procedures have failed to yield results.

Abdomen↗

PubMed2000

Laparoscopy in the evaluation of the incarcerated mass in groin hernia.

BACKGROUND: In hernia patients, the preoperative diagnosis of strangulation is difficult. In this prospective study, we investigated the usefulness of an exploratory laparoscopy to evaluate the viability of a viscus incarcerated in a groin hernia. METHODS: Twenty-seven patients with an acute irreducible inguinal mass underwent exploratory laparoscopy. The hernia was reduced, and the viability of the incarcerated viscus was judged laparoscopically on the basis of color, congestion, and contractility. RESULTS: Twenty-four hernias were found. In sixteen patients, the contents of the hernia were viable. In five patients, a necrotic bowel segment was found, and a laparotomy and resection were done. In three patients, no hernias were found. The cause of inguinal pain was spermatic cord hematoma in one patient and inguinal abscess in another; however, the cause of pain in the third patient remained unclear. After laparotomy, one patient developed a fascial rupture that required reoperation. There were no other complications. CONCLUSION: At laparoscopy, the judgment of the viability of the contents of the hernia is similar to that at laparotomy. The early use of laparoscopy can prevent many unnecessary laparotomies.

Adolescent↗

PubMed2000

Emergency laparoscopy: a community hospital experience.

BACKGROUND: By now, laparoscopic surgery has achieved widespread acceptance among surgeons and, generally speaking, by the public. Therefore, we set out to evaluate whether this technique is a feasible method of treating patients with abdominal emergencies, traumatic or not. To assess the routine use of emergency laparoscopy in a community hospital setting, we undertook a retrospective analysis of an unrandomized experience (presence or absence of a surgeon with laparoscopic experience). METHODS: Between January 1993 and October 1998, 575 emergency abdominal surgical procedures were done in our department. In all, 365 (63.4%) were diagnostic and operative laparoscopy procedures (acute small bowel obstruction: 23 cases; hernia disease: one case; gastroduodenal ulcer disease: 15 cases; biliary system disease: 89 cases; pelvic disease: 237 cases). These cases represent almost 56% of all laparoscopic procedures done during the same period at our institution. Laparoscopy was not performed in patients with a history of a previous abdominal approach to malignant disease, a history of more than two major abdominal surgeries, or massive bowel distension; nor was it used in patients whose general conditions contraindicate this approach. RESULTS: The conversion rate was 6.8%. The morbidity and mortality rates were, respectively, 4.1% and 0.8%. A definitive diagnosis was provided in 95.3% of cases, with the possibility to treat 88.2% of them by laparoscopy. CONCLUSIONS: We consider the laparoscopic approach in patients with abdominal emergencies to be feasible and safe in experienced hands. It provides diagnostic accuracy as well as therapeutic capabilities. Sparing patients laparotomy reduces postoperative pain, improves recovery of GI function, reduces hospitalization, cuts health care costs, and improves cosmetic results. This approach promises to play a significant role in emergency abdominal situations and will certainly become increasingly important in today's health care environment.

Adult↗

PubMed2000

Delayed laparoscopy facilitates the management of biliary peritonitis in patients with complex liver injuries.

BACKGROUND: Nonoperative management is now regarded as the best alternative for the treatment of patients with complex blunt liver injuries. However, some patients still require surgical treatment for complications that were formerly managed with laparotomy and a combination of image-guided studies. METHODS: We reviewed the medical records of 15 patients who had complex blunt liver injuries that were managed nonoperatively and in which biliary peritonitis developed. RESULTS: Delayed laparoscopy was performed 2-9 days after admission in patients with extensive liver injuries. All 15 patients had developed local signs of peritonitis or a systemic inflammatory response. Laparoscopy was indicated to drain a large retained hemoperitoneum (eight patients), bile peritonitis (four patients), or an infected perihepatic collection (three patients). Laparoscopy was successful in all patients, and there was no need for further interventions. CONCLUSION: The data indicate that as more patients with complex liver injuries are treated nonoperatively and the criteria for nonoperative management continue to expand, more patients will need some type of interventional procedure to treat complications that historically were managed by laparotomy. At this point, laparoscopy is an excellent alternative that should become part of the armamentarium of the trauma surgeons who treat these patients.

Adolescent↗