title: "Awake" laparoscopy for the evaluation of equivocal penetrating abdominal wounds.
abstract: BACKGROUND
  Diagnostic laparoscopy is useful for the assessment of equivocal penetrating abdominal wounds, and has become the modality of choice for the evaluation of such wounds at our institution. We hypothesised that, in appropriate patients, diagnostic "awake" laparoscopy (AL) could be performed under local anaesthesia in the emergency department (ED), allowing for expedited discharge and potential cost savings.
  
  
  METHODS
  Selected haemodynamically stable patients with penetrating abdominal injury underwent AL. Suitability for AL was at the discretion of the attending surgeon. Identification of peritoneal penetration by AL led to exploratory laparotomy in the operating room. Patients with no evidence of peritoneal penetration were discharged from the ED (ALneg). These patients were matched to a cohort of 24 patients who underwent diagnostic laparoscopy in the OR which was negative for peritoneal penetration (DLneg). Length of stay and hospital charges were compared.
  
  
  RESULTS
  Over a 30-month period, 15 patients underwent AL without complication. No peritoneal penetration was found in 11 patients. The remaining four patients underwent exploratory laparotomy, of which two were positive for intra-abdominal injury. Mean time to discharge was 7h in the ALneg group versus 18 h in the DLneg group (p=0.0003). Cost savings on hospital charges averaged 2227 US dollars per patient in the ALneg group compared with the DLneg group.
  
  
  CONCLUSIONS
  AL may be safely performed in the ED, allowing for expedited patient discharge. Cost savings are achieved by the avoidance of charges inherent to diagnostic laparoscopy performed in the operating room.
authors.affiliation: Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Jordan A
authors.initials: JA
authors.lastname: Weinberg
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Magnotti
authors.forename: Norma M
authors.initials: NM
authors.lastname: Edwards
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Claridge
authors.forename: Gayle
authors.initials: G
authors.lastname: Minard
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Fabian
authors.forename: Martin A
authors.initials: MA
authors.lastname: Croce
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000191:economics; D000328:Adult; D000772:Anesthesia, Local; D004636:Emergency Service, Hospital; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D007813:Laparotomy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010537:Peritoneum / Q000293:injuries; D014481:United States; D014948:Wounds, Gunshot / Q000175:diagnosis; D014950:Wounds, Penetrating / Q000175:diagnosis* / Q000191:economics; D014951:Wounds, Stab / Q000175:diagnosis