The role of minimally invasive surgery in the forward combat hospital

Background: Most penetrating abdominal combat wounds are of high energy, with injury to multiple viscera, and require immediate open abdominal exploration for hemorrhage control. There is interest in advanced surgical systems for use in the forward combat environment, but minimally invasive surgery (MIS) has never been utilized in such setting. The authors hand-carried an MIS capability into a major trauma center in Iraq, and report our experience incorporating MIS into forward trauma surgical care.
Methods: The Air Expeditionary Force rotation 9 recorded all patient encounters and operative reports on prospective databases, and the authors reviewed these data retrospectively.
Results: Between 19 Jan 06 and 17 May 06, 85 patients required emergent abdominal operation. Of the 67 patients requiring emergent abdominal operation due to traumatic injury, 16 previously had undergone laparotomy by a Forward Surgical Team. Of the 51 injured patients presenting initially to our center, 8 had low-energy abdominal fragment injury, and underwent diagnostic laparoscopy. In addition, 12 of the 18 patients with non-traumatic acute abdominal conditions were managed by MIS, 3 patients were treated by video assisted thoracic surgery for traumatic injury, and 6 patients required emergency therapeutic gastrointestinal endoscopy.
Conclusions: Despite the numerous barriers to providing MIS in the forward combat surgical environment, MIS has a limited role and serves as a force-multiplier, by returning injured and ill personnel rapidly to duty.


Session: Podium Presentation

Program Number: S049

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