Laparoscopic Exploration for Free Air
2018
Laparoscopic exploration is a minimally invasive approach for the investigation and potential intervention of pneumoperitoneum or intra-abdominal free air. The procedure begins with preoperative planning, standardization of personnel, and operating room setup. Success mandates expedited mobilization of instruments and resources, especially after hours and on weekends. The procedure entails safe entry into the abdomen, thorough examination of the intra-abdominal organs, retroperitoneal surfaces, peritoneal lining, and free peritoneal fluid. Adjuncts such as intraoperative esophagogastroduodenoscopy, methylene blue, and newer endoscopic fluorescence imaging techniques can help assess tissue integrity and identify pathology. Finally, the surgeon must maintain open communication with the surgical and anesthesia teams to promptly recognize the potential adverse consequences of pneumoperitoneum or deteriorating patient physiology that could warrant conversion to open procedure. Laparoscopic exploration for free air is safe and feasible. With the increased implementation of minimally invasive techniques as a core part of surgical training, more research showing the safety and efficacy of laparoscopic procedures in the emergent setting, and the support of surgical societies, this approach will become more common.
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