title: Advances in laparoscopy for acute care surgery and trauma.
abstract: The greatest advantages of laparoscopy when compared to open surgery include the faster recovery times, shorter hospital stays, decreased postoperative pain, earlier return to work and resumption of normal daily activity as well as cosmetic benefits. Laparoscopy today is considered the gold standard of care in the treatment of cholecystitis and appendicitis worldwide. Laparoscopy has even been adopted in colorectal surgery with good results. The technological improvements in this surgical field along with the development of modern techniques and the acquisition of specific laparoscopic skills have allowed for its utilization in operations with fully intracorporeal anastomoses. Further progress in laparoscopy has included single-incision laparoscopic surgery and natural orifice trans-luminal endoscopic surgery. Nevertheless, laparoscopy for emergency surgery is still considered challenging and is usually not recommended due to the lack of adequate experience in this area. The technical difficulties of operating in the presence of diffuse peritonitis or large purulent collections and diffuse adhesions are also given as reasons. However, the potential advantages of laparoscopy, both in terms of diagnosis and therapy, are clear. Major advantages may be observed in cases with diffuse peritonitis secondary to perforated peptic ulcers, for example, where laparoscopy allows the confirmation of the diagnosis, the identification of the position of the ulcer and a laparoscopic repair with effective peritoneal washout. Laparoscopy has also revolutionized the approach to complicated diverticulitis even when intestinal perforation is present. Many other emergency conditions can be effectively managed laparoscopically, including trauma in select hemodynamically-stable patients. We have therefore reviewed the most recent scientific literature on advances in laparoscopy for acute care surgery and trauma in order to demonstrate the current indications and outcomes associated with a laparoscopic approach to the treatment of the most common emergency surgical conditions.
authors.affiliation: Matteo Mandrioli, Alice Piccinini, Andrea Biscardi, Elio Jovine, Gregorio Tugnoli, Salomone Di Saverio, Department of Emergency and General Surgery and Trauma Surgery Unit, C. A. Pizzardi Maggiore Hospital Trauma Center, 40133 Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Mandrioli
authors.affiliation: Matteo Mandrioli, Alice Piccinini, Andrea Biscardi, Elio Jovine, Gregorio Tugnoli, Salomone Di Saverio, Department of Emergency and General Surgery and Trauma Surgery Unit, C. A. Pizzardi Maggiore Hospital Trauma Center, 40133 Bologna, Italy.
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.affiliation: Matteo Mandrioli, Alice Piccinini, Andrea Biscardi, Elio Jovine, Gregorio Tugnoli, Salomone Di Saverio, Department of Emergency and General Surgery and Trauma Surgery Unit, C. A. Pizzardi Maggiore Hospital Trauma Center, 40133 Bologna, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Piccinini
authors.affiliation: Matteo Mandrioli, Alice Piccinini, Andrea Biscardi, Elio Jovine, Gregorio Tugnoli, Salomone Di Saverio, Department of Emergency and General Surgery and Trauma Surgery Unit, C. A. Pizzardi Maggiore Hospital Trauma Center, 40133 Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Biscardi
authors.affiliation: Matteo Mandrioli, Alice Piccinini, Andrea Biscardi, Elio Jovine, Gregorio Tugnoli, Salomone Di Saverio, Department of Emergency and General Surgery and Trauma Surgery Unit, C. A. Pizzardi Maggiore Hospital Trauma Center, 40133 Bologna, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Sartelli
authors.affiliation: Matteo Mandrioli, Alice Piccinini, Andrea Biscardi, Elio Jovine, Gregorio Tugnoli, Salomone Di Saverio, Department of Emergency and General Surgery and Trauma Surgery Unit, C. A. Pizzardi Maggiore Hospital Trauma Center, 40133 Bologna, Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Agresta
authors.affiliation: Matteo Mandrioli, Alice Piccinini, Andrea Biscardi, Elio Jovine, Gregorio Tugnoli, Salomone Di Saverio, Department of Emergency and General Surgery and Trauma Surgery Unit, C. A. Pizzardi Maggiore Hospital Trauma Center, 40133 Bologna, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Catena
authors.affiliation: Matteo Mandrioli, Alice Piccinini, Andrea Biscardi, Elio Jovine, Gregorio Tugnoli, Salomone Di Saverio, Department of Emergency and General Surgery and Trauma Surgery Unit, C. A. Pizzardi Maggiore Hospital Trauma Center, 40133 Bologna, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cirocchi
authors.affiliation: Matteo Mandrioli, Alice Piccinini, Andrea Biscardi, Elio Jovine, Gregorio Tugnoli, Salomone Di Saverio, Department of Emergency and General Surgery and Trauma Surgery Unit, C. A. Pizzardi Maggiore Hospital Trauma Center, 40133 Bologna, Italy.
authors.forename: Elio
authors.initials: E
authors.lastname: Jovine
authors.affiliation: Matteo Mandrioli, Alice Piccinini, Andrea Biscardi, Elio Jovine, Gregorio Tugnoli, Salomone Di Saverio, Department of Emergency and General Surgery and Trauma Surgery Unit, C. A. Pizzardi Maggiore Hospital Trauma Center, 40133 Bologna, Italy.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Tugnoli
authors.affiliation: Matteo Mandrioli, Alice Piccinini, Andrea Biscardi, Elio Jovine, Gregorio Tugnoli, Salomone Di Saverio, Department of Emergency and General Surgery and Trauma Surgery Unit, C. A. Pizzardi Maggiore Hospital Trauma Center, 40133 Bologna, Italy.
authors.forename: Salomone
authors.initials: S
authors.lastname: Di Saverio
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000601:surgery*; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000369:Aged, 80 and over; D002983:Clinical Competence; D004059:Diffusion of Innovation; D004066:Digestive System Diseases / Q000175:diagnosis / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D059032:Learning Curve; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Acute care surgery; Laparoscopy; Natural orifice trans-luminal endoscopic surgery; Single-incision laparoscopic surgery; Trauma
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