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 activ...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.展开更多
Purpose:Although there are significant differences between China and the United States(US)in trauma medical services,there has been no direct comparative research on the epidemiological data of trauma centers between ...Purpose:Although there are significant differences between China and the United States(US)in trauma medical services,there has been no direct comparative research on the epidemiological data of trauma centers between the 2 countries.This study aims to fill this research gap by directly comparing trauma centers in China and the US,providing valuable data and insights for the development of trauma centers in both countries,promoting academic exchange and cooperation internationally,and enhancing the level of global trauma medical care.Methods:This is a multicenter retrospective descriptive study.Data were collected for trauma patients with an injury severity score≥16 treated from September 2013 to September 2019 at 2 hospital trauma centers in these 2 countries.Detailed clinical data(including injury mechanism,age,injury site,injury severity score,pre-hospital transport time,whether blood transfusion was performed,whether resuscitative thoracotomy was conducted,hospital and intensive care unit stay duration,the number of organ donor patients,mortality rates,and costs)were meticulously compiled and retrospectively analyzed to identify differences between the 2 trauma centers.The comparison was conducted using SPSS 23 software.Continuous variables are reported as median(Q_(1),Q_(3)),and Mann WhitneyU test is used to compare the median of continuous variables.Use clinically relevant critical points to classify continuous variables,with categorical variables represented asn(%),and comparisons were made between the 2 groups using the χ^(2) test or Fisher''s exact test.Statistical significance was defined as a 2-sidedp<0.05.Results:These results point to significant differences in trauma center capacity,pre-hospital transport times,treatment procedures,hospital stay duration,mortality rates,and costs between the 2 centers.The volume of patients in trauma centers is less in China(2465vs.5288).Pre-hospital transport time was notably longer in China(180 minvs.14 min),and the rate of emergency blood transfusions was lower in China(18.4%vs.50.6%),Emergency thoracotomy was not performed in China but was conducted in 9.8% of cases in the US.Hospitalization costs were significantly lower in China than in the US($5847vs.$75,671).Conclusion:There are clear differences in trauma center capacity(number of patients treated),pre-hospital transport time,age distribution of injured patients,injury mechanisms,injury sites,whether emergency thoracotomy is performed,hospital costs,and length of stay between the 2 trauma centers in China and America.Understanding these differences can help us further recognize the characteristics of Eastern and Western trauma patients.展开更多
文摘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.
文摘Purpose:Although there are significant differences between China and the United States(US)in trauma medical services,there has been no direct comparative research on the epidemiological data of trauma centers between the 2 countries.This study aims to fill this research gap by directly comparing trauma centers in China and the US,providing valuable data and insights for the development of trauma centers in both countries,promoting academic exchange and cooperation internationally,and enhancing the level of global trauma medical care.Methods:This is a multicenter retrospective descriptive study.Data were collected for trauma patients with an injury severity score≥16 treated from September 2013 to September 2019 at 2 hospital trauma centers in these 2 countries.Detailed clinical data(including injury mechanism,age,injury site,injury severity score,pre-hospital transport time,whether blood transfusion was performed,whether resuscitative thoracotomy was conducted,hospital and intensive care unit stay duration,the number of organ donor patients,mortality rates,and costs)were meticulously compiled and retrospectively analyzed to identify differences between the 2 trauma centers.The comparison was conducted using SPSS 23 software.Continuous variables are reported as median(Q_(1),Q_(3)),and Mann WhitneyU test is used to compare the median of continuous variables.Use clinically relevant critical points to classify continuous variables,with categorical variables represented asn(%),and comparisons were made between the 2 groups using the χ^(2) test or Fisher''s exact test.Statistical significance was defined as a 2-sidedp<0.05.Results:These results point to significant differences in trauma center capacity,pre-hospital transport times,treatment procedures,hospital stay duration,mortality rates,and costs between the 2 centers.The volume of patients in trauma centers is less in China(2465vs.5288).Pre-hospital transport time was notably longer in China(180 minvs.14 min),and the rate of emergency blood transfusions was lower in China(18.4%vs.50.6%),Emergency thoracotomy was not performed in China but was conducted in 9.8% of cases in the US.Hospitalization costs were significantly lower in China than in the US($5847vs.$75,671).Conclusion:There are clear differences in trauma center capacity(number of patients treated),pre-hospital transport time,age distribution of injured patients,injury mechanisms,injury sites,whether emergency thoracotomy is performed,hospital costs,and length of stay between the 2 trauma centers in China and America.Understanding these differences can help us further recognize the characteristics of Eastern and Western trauma patients.
