Laparoscopy in Trauma: Can Brazil fit into the global trend?

Two decades ago, laparoscopy inaugurated a new era in the treatment of trauma victims, allowing surgeons to diagnose intra-abdominal injuries in a minimally invasive way. However, the high incidence of unnoticed lesions was a reason for resistance to implementing the method as a routine1-3. With the improvement of video equipment, the greater experience of surgeons, the standardization of the exam for laparoscopy in trauma, and the adequate selection of patients, diagnostic laparoscopy was safely incorporated in the management of these patients, avoiding unnecessary laparotomies4-8. Once the need for therapeutic procedures is confirmed, laparotomy is still the routine access route. The current discussion revolves around therapeutic laparoscopy, that is, the concrete possibility not only of diagnosing, but of treating traumatic injuries, even in the case of multiple lesions, of different degrees of complexity, both in penetrating and blunt trauma, the latter being even more challenging9,10. The relevance of the subject today can be proven by the growing number of scientific publications. In a search in the Pubmed database with the keywords “abdominal trauma” and “laparoscopy”, one finds 300 results from the last 20 years, 60% of which in the last 10 years (2013-2023) and 30% in the last five years (2018-2023). Restricting the search with the descriptors “abdominal trauma” and “therapeutic laparoscopy” renders 37 results in the last 20 years, 73% in the last 10 years (2013-2023) and 49% in the last five years (2018-2023). In the ideal scenario, the care of trauma patients should be performed by an emergency surgeon trained to treat trauma. The discussion on how to train a trauma surgeon remains elusive. This specialist is often seen as a surgeon specializing in critical care and advanced clinical support. To safely insert the minimally invasive technique in trauma, there must be an association of the surgeon’s experience in caring for traumatized patients (multidisciplinary approach) and the technical qualification in advanced laparoscopic procedures, which are acquired in the elective or non-traumatic emergency settings11-13. The emergency surgeon who does not work with elective surgeries has fewer opportunities to perform minimally invasive operations, reflecting in a lower technical capacity to perform advanced laparoscopic procedures. The skill in laparoscopy is divided into three groups of procedures: 1) Group 1 – Basic procedures (i.e., appendectomy and cholecystectomy); 2) Group 2 – Intermediate procedures (i.e., Gastric fundoplication, hernioplasty, gastrointestinal suture, sleeve gastrectomy, and splenectomy); and 3) Group 3 – Advanced procedures (i.e., esophagectomy, gastrectomy, colectomy, pancreatectomy, gastric bypass, and hepatectomy). The basic skills needed to perform laparoscopy in trauma are properly positioning the patient, handling the camera accurately, safely moving the organs in the abdominal cavity, inspecting intestinal loops, performing sutures, and applying hemostasis techniques11. These skills can be acquired by performing exercises in a box with a camera, using virtual reality simulators, or handling tissues