Advances in laparoscopy for acute care surgery and trauma

Figure 1 Single-incision laparoscopic surgery appendectomy in a 14 year old female: Umbelical scar after 8 post-operative days. Provided by personal courtesy of Dr. S. Di Saverio, MD, FACS, FRCS.

Figure 2 Single-incision laparoscopic surgery to multiport laparoscopic conversion. Right colectomy for intended appendectomy: functional and aesthetic outcome. The procedure began as an intended single-incision laparoscopic surgery appendectomy. After discovering a wide perforation of the gangrenous cecum, the procedure was converted to a multiport laparoscopic right colectomy. With an umbelical port for the camera, two further trocars were inserted: a 5 mm trocar in the left iliac fossa and a 12 mm trocar in the left flank as an opertive port and for the insertion of the endostapler. Provided by personal courtesy of Dr. S. Di Saverio, MD, FACS, FRCS.

Figure 3 Laparoscopic adhesiolysis for small bowel obstruction following pedriatic surgery with median laparotomy: Functional and aesthetic outcome. The camera was in the Hasson trocar in the paraumbelical port. Two operative 5 mm trocars were placed in the left hypocondrium and in the left iliac fossa respectively. Provided by personal courtesy of Dr. S. Di Saverio, MD, FACS, FRCS.

Figure 4 Laparoscopic Hartmann’s procedure for perforated Hinchey III diverticulitis in a 39 years old female: End colostomy and drains. On the right iliac fossa a large 12 mm port was used for introducing the endostapler and for distal colonic resection. On the left flank, a fourth port was inserted for the assistant surgeon. The sigmoid was then extracted from the left flank by enlarging the port to a 4 cm incision. The end colostomy was then fashioned on the left flank using the same incision. Provided by personal courtesy of Dr. S. Di Saverio, MD, FACS, FRCS.

Figure 5 Resection with primary anastomosis for Hinchey IV diverticulis in a young patient: Functional and aesthetic outcome. A suprapubic 12 mm trocar was used for introducing the endostapler and performing the fully intracorporeal anastomosis. The specimen was then extracted by enlarging the suprapubic incision to a 4 cm minilaparotomy. Provided by personal courtesy of Dr. S. Di Saverio, MD, FACS, FRCS.

Figure 6 A four-trocar laparoscopic gastroduodenal resection for duodenal perforation. A: “Open-book” duodenal perforation; B: Dissecting the inflamed pylorus from the head of the pancreas; C: Duodenal resection; D: Oversewing the duodenal stump; E: Performing latero-lateral intra-corporeal stapled anastomosis on the posterior stomach wall; F: Closing the enterotomy with interrupted stitches; G: Functional and aesthetic outcome. Provided by personal courtesy of Dr. S. Di Saverio, MD, FACS, FRCS.

Figure 7 Nine post-operative days after laparoscopic repair of a perforated peptic ulcer: functional and aesthetic outcome. Provided by personal courtesy of Dr. S. Di Saverio, MD, FACS, FRCS.

Figure 8 A large completely perforated jejunum mesenteric border with a 180° laceration of the wall. A: Peritoneal penetration; B: Laparoscopic exploration and individuation of the site of the perforation; C: Wide perforation of the ileus; D: Performing latero-lateral intra-corporeal stapled anastomosis after a limited jejunal resection; E: Functional and aesthetic outcome. Provided by personal courtesy of Dr. S. Di Saverio, MD, FACS, FRCS.

Figure 9 Laparoscopic repair of intestine perforation following a blunt abdominal trauma. A: Individuation of the site of perforation; B: Defect repair by direct suture; C: Functional and aesthetic outcome. Provided by personal courtesy of Dr. S. Di Saverio, MD, FACS, FRCS.