The Use of Bedside Diagnostic Laparoscopy in the Intensive Care Unit

Karasakalides, A.; Triantafillidou, Sofia; Anthimidis, Georgios; Ganas, E.; Mihalopoulou, Evangelia; Lagonidis, D.; Nakos, George

doi:10.1089/lap.2008.0279

Cited by 11 publications

(16 citation statements)

References 17 publications

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“…Laparoscopy is another surgical procedure that has been reported to be performed at the bedside in ICU in patients with acute abdomen [10,23,24]. A recent study on 62 critically ill patients showed bedside laparoscopy to be useful for obtaining a diagnosis in patients with acute abdomen [9].…”

Section: Discussionmentioning

confidence: 99%

Rescue bedside laparotomy in the intensive care unit in patients too unstable for transport to the operating room

et al. 2014

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IntroductionThe prognoses of critically ill patients with a requirement for emergency laparotomy and severe respiratory and/or hemodynamic instability precluding transport to the operating room (OR) are often fatal without surgery. Attempting emergency surgery at the bedside might equally result in an adverse outcome. However, risk factors and predictors that could support clinical decision making have not been identified so far. This study describes the clinical characteristics, indicative pathophysiology and outcomes in patients undergoing resuscitative laparotomy in the intensive care unit (ICU).MethodsThis was a retrospective observational study of all critically ill adult patients undergoing resuscitative laparotomy in the ICUs of a German university hospital from January 2005 to July 2013. Clinical characteristics, risk factors, and treatments were compared between survivors and non-survivors. The primary endpoint was 28-day survival.ResultsA total of 41 patients with a median age of 64 (21 to 83) were included. The most frequent reasons for ICU admission were sepsis, pneumonia, and pancreatic surgery. All patients were mechanically ventilated, receiving vasopressors, and were in multiple organ failure. Twenty-nine patients (70.7%) were on renal replacement therapy and two patients (4.9%) on extracorporeal membrane oxygenation. The main reasons for surgery were suspected intra-abdominal bleeding (39.0%), suspected intestinal ischemia (24.4%) or abdominal compartment syndrome (24.4%). Twenty-eight-day, ICU and hospital mortalities were 75.6%, 80.5%, and 82.9%, respectively. In six out of ten patients (60%) who survived surgery for more than 28 days, bedside laparotomy was rated as a life-saving procedure by an interdisciplinary group of the investigators.ConclusionsThese findings suggest that in selected critically ill patients with a vital indication for emergency laparotomy and severe cardiopulmonary instability precluding transport to the OR, a bedside resuscitative laparotomy in the ICU can be considered as a rescue procedure, even though very high mortality is to be expected.

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Section: Discussionmentioning

confidence: 99%

Rescue bedside laparotomy in the intensive care unit in patients too unstable for transport to the operating room

et al. 2014

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“…The decision to take a patient to the operating room for diagnostic laparoscopy or laparotomy subjects that patient to the risk of complication with the potential for a negative exploration. Negative diagnostic evaluations in the critically ill have been reported at [60% in some series [1][2][3][4][5][6][7][8][9][10][11], which subjects a large number to an unnecessary surgical procedure. There also is a select group of these patients who have an incurable premorbid condition (i.e., diffuse ischemic bowel).…”

Section: Discussionmentioning

confidence: 99%

“…Implementing a bedside diagnostic NOTES procedure in the ICU may provide an alternative option and could prove beneficial to this difficult population of patients. Bedside explorations via a laparoscopic approach have been reported advantageous repeatedly for diagnostic or even basic therapeutic interventions [7][8][9][10][11], although, despite good results, it consistently remains a poorly accepted and utilized application in the ICU. Contributing factors for its rare use have been the cumbersome nature of transporting the equipment and the number of resources required to facilitate the procedure in an urgent setting.…”

Section: Discussionmentioning

confidence: 99%

“…Identifying the etiology of sepsis in these patients is frequently a challenging process, and many times the surgeon is forced to explore them operatively to determine the diagnosis. This, however, can place a patient at grave risk by exposing them to an invasive procedure that often times results in negative findings (Table 1) [1][2][3][4][5][6][7][8][9][10][11]. A diagnostic bedside NOTES peritoneoscopy may have a benefit in these circumstances.…”

Section: Introductionmentioning

confidence: 99%

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The diagnostic efficacy of natural orifice transluminal endoscopic surgery: is there a role in the intensive care unit?

et al. 2010

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The utilization of NOTES as a diagnostic tool may have an important role in the critically ill patient when operative intervention is highly morbid. Although it may be overall inferior diagnostically compared with laparoscopy, a positive identification was highly specific with a strong predictive value. Further investigation addressing an improved small bowel evaluation technique would be beneficial. A human trial of NOTES in the ICU utilizing the current technology would still initially mandate laparoscopic or open surgical confirmation and treatment.

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“…Inhaled anesthetics are not necessarily excluded from the ICU, but performing laparoscopy under local anesthesia with intravenous sedation is feasible as evidenced by many studies. 11,14,17,19 The transumbilical technique is most commonly used to enter the abdomen unless the patient has had prior midline surgery involving the umbilicus. In that setting, access can be obtained by open technique (our approach) at either upper quadrant at the tip of the 11th rib.…”

Section: Laparoscopic Physiology and Techniquesmentioning

confidence: 99%

Diagnostic Laparoscopy in the Intensive Care Unit

Zemlyak

Heniford

Sing

2013

J Intensive Care Med

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Primary and acquired abdominal pathology accounts for a significant proportion of sepsis and SIRS in the ICU population. Abdominal processes often present a difficult diagnostic dilemma in the truly critically ill patient who, due to hemodynamic instability or severe acute respiratory distress syndrome (ARDS) requiring high-level ventilatory support, is at significant risk during transport to radiology department. Furthermore, the accuracy of radiologic studies in the ICU setting is often limited. Laparoscopy provides a "minimally invasive" definitive modality to diagnose intra-abdominal problems. It may quickly provide the necessary information to define further management. In selective circumstances, it may actually allow appropriate intervention. However, the overall mortality of patients who undergo diagnostic laparoscopy in the ICU is high regardless of diagnostic findingsduring this procedure. Although not a technically difficult procedure, diagnostic laparoscopy does require a certain skill level, especially when limited time and unfavorable patient physiology are taken into account. The use of diagnostic laparoscopy should be limited to patients in whom a therapeutic intervention is feasible.

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The Use of Bedside Diagnostic Laparoscopy in the Intensive Care Unit

Cited by 11 publications

References 17 publications

Rescue bedside laparotomy in the intensive care unit in patients too unstable for transport to the operating room

Rescue bedside laparotomy in the intensive care unit in patients too unstable for transport to the operating room

The diagnostic efficacy of natural orifice transluminal endoscopic surgery: is there a role in the intensive care unit?

Diagnostic Laparoscopy in the Intensive Care Unit

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