Page 18 - World Journal of Laparoscopic Surgery

WJOLS

Ebrahim Mansoor, RK Mishra 10.5005/jp-journals-10033-1288
REVIEW ARTICLE

Challenges in the Widespread use of Minimal

Access Surgery for the Management of
Abdominal Trauma: A Primer

2
1 Ebrahim Mansoor, RK Mishra

ABSTRACT However, the therapeutic benefit appears illegitimately
Minimal access surgery (MAS) has made great strides in the more controversial and general skepticism still prevails.
evaluation and treatment of elective surgical pathology. The
use of MAS for intervention in the patient with abdominal AIMS
trauma has cautiously lagged behind. We undertook an in-
depth analysis of published surgical literature in this regard. • Review the surgical literature to assess the current
The aim was essentially to succinctly summarize current global stance for the use of MAS in the trauma setting.
evidence and identify obstacles to its more widespread use. • Identify challenges and obstacles to more widespread
Lack of skill and experience has been identified as the main use of MAS for abdominal trauma.
factor. Addressing this issue with further training and educa- • Suggest possible solutions to the challenges and
tion will be the panacea for the success of MAS for abdominal
trauma henceforth. Nevertheless, laparoscopy remains an obstacles with a view to maximizing the benefits of
integral component of the surgical armamentarium in dealing MAS for the trauma patients.
with abdominal trauma.
MATERIALS AND METHODS
Keywords: Blunt, Laparoscopy, Minimal access, Penetrating,
Trauma. • A thorough online search of the surgical literature
regarding the relationship of MAS and abdominal
How to cite this article: Mansoor E, Mishra RK. Challenges
in the Widespread use of Minimal Access Surgery for the trauma was conducted.
Management of Abdominal Trauma: A Primer. World J Lap • Google Scholar, HighWire Press, and PubMed data-
Surg 2016;9(3):122-125. bases were used for the purpose of literature review.
Source of support: Nil • Main keywords used in the search were “laparos-
copy,” “minimal access,” and “abdominal trauma.”
Conflict of interest: None
• Emphasis was placed on literature published in the
last decade, that is, from 2005 onward.
INTRODUCTION
RESULTS
Since the advent of minimal access surgery (MAS),
patients have benefitted from all its purported advan- The results of 11 randomly selected papers are shown
tages. Less pain, earlier mobilization, reduced wound on the next page.
sepsis, and limited hospital stay are just some of the Studies evaluating the relationship of MAS and
features of MAS that has sparked interest for its use in abdominal trauma are marred by heterogeneity. In addi-
the trauma patient. The reduced financial implication tion, the majority of these studies are retrospective and
was of further relevance to developing countries plagued have small population sizes. Conversion rates are heavily
by a high trauma rate. After the initial enthusiasm for influenced by surgeon preference, institutional protocol
MAS in the elective setting, it began to be utilized for the and algorithms, surgeon skill and experience, and the
availability of suitable equipment and adjuncts, such as
trauma patient. Several studies have since attested to the energy devices and surgical staplers. As such, the results
applicability of MAS for trauma, mainly for diagnosis.
are entrenched in selection bias. While the mean success
rate for MAS in abdominal trauma is approximately 80%,
there is definitely room for improvement. Authors are
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1 Specialist, Consultant Laparoscopic Surgeon
unanimous in identifying lack of skill and experience as
1 Department of General Surgery, University of KwaZulu-Natal the Achilles heel to the more widespread use of laparos-
Durban, South Africa
copy in abdominal trauma.
2 World Laparoscopy Hospital, Gurgaon, Haryana, India There is a general consensus that MAS is safe and
Corresponding Author: Ebrahim Mansoor, Specialist cost-effective in the management of blunt and penetrating
Department of General Surgery, University of KwaZulu-Natal abdominal trauma. Furthermore, it has been shown to
Durban, South Africa, e-mail: dremansoor@gmail.com
markedly limit the number of unnecessary laparotomies.
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