Laparoscopy in Trauma: Analysis of Publication History and Study Demographics from 1925 to 2015

Nova Szoka, MD1, Lauren Coleman2, Gareth Gilna2, Dana Portenier, MD1, Edward Auyang, MD, MS2. 1Duke University, 2University of New Mexico

INTRODUCTION: The use of laparoscopy in trauma surgery remains a debated topic. Although laparoscopic treatment of injured patients has been discussed in the literature for decades, a consensus amongst trauma providers regarding its use has yet to be reached. Our objective was to document the publication history of trauma laparoscopy and identify any trends, as well as analyze study demographics, with hopes to better inform future areas of research.

METHODS AND PROCEDURES: A Medline search was performed of English literature using the terms wounds, injuries, trauma, and laparoscopy. The references of each article were also searched. Articles were excluded if laparoscopy was not performed during the initial hospital admission. Year published, number of subjects, study design, mechanism, type of laparoscopy, journal, and location of study were recorded. Type of laparoscopy is defined as: screening (detecting signs of injury that are repaired via laparotomy), therapeutic (detection/repair of all injuries) or diagnostic (identifying injuries/triaging patients as: injury free, with nonoperative injury, or with injury requiring further operative intervention).

RESULTS: From 1925 to 2015, 201 English-language articles on trauma laparoscopy, encompassing 12,577 subjects, have been published (Figure 1). Type of studies include: 64 case reports(32%), 104 case series(52%), 22 reviews(11%), 5 randomized controlled trials(2.5%), and one systematic review(0.5%).  Mechanism was blunt in 73 studies(36%, n=3707), penetrating in 66(33%, n=4755), and 58(29%, n=4095) studies included both mechanisms.  Type of laparoscopy performed in each article was screening in 19(9%), diagnostic in 66(33%), therapeutic in 43(21%) and both diagnostic & therapeutic in 47(23%) (Figure 2). The main journals involved were: Journal of Trauma (26 articles, 13%), Surgical Endoscopy (25 articles, 12%), Journal of Laparoendoscopic Surgery (11 articles, 5%) and American Journal of Surgery (11 articles, 5%).  Fifty-four percent (109 publications) originated in the United States, 31% in Europe (46 publications), and 8% in Asia (16 publications).

CONCLUSIONS: Trauma laparoscopy is becoming a tool in the armamentarium of the trauma surgeon, and the number of publications examining laparoscopy to treat injured patients continues to grow. Over the past 90 years, the type of laparoscopy performed has evolved from a screening tool into a diagnostic and therapeutic modality. Despite the large number of publications, there is a need for adequately powered, randomized controlled studies to further support this approach. 

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