Laparoscopy in the Emergency Room

Article Conference CoverageFrom Society of Laparoscopic SurgeonsNew York, December, 1999

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Dr. Larry Demco: "I'm Larry Demco from the Society of Laparoendoscopic Surgery from New York, and we'd like to interview Dr. Jay Redan from Pennsylvania. Dr. Redan has introduced a new concept here at the meeting on laparoscopy in the emergency room. Jay, can you give us a little run-down on how we can use laparoscopy in the emergency room?"

Dr. Jay Redan: "When patients come to the emergency room they're coming in acutely with pain, and the patients and their families want to know an immediate diagnosis as far as the etiology. Therefore, by doing laparoscopy right in the emergency room, you can identify the problem and initiate treatment right away."

Dr. Larry Demco: "How does the staff in the emergency room view you doing an invasive procedure in the emergency room?"

Dr. Jay Redan: "At first they were quite skeptical. Anytime you're going to do anything invasive in the emergency room, it does alter the usual homeostasis in the department. But once they saw how effective it was in identifying and treating the patients and getting an immediate answer, they became much more receptive and also very comfortable with the use of conscious sedation."

Dr. Larry Demco: "How successful are you in starting a procedure versus having to abort it and go to the operating room?"

Dr. Jay Redan: "Usually after a careful history and physical, you have a fairly good idea of what the cause is. Therefore, we're usually about 80%-85% successful in making diagnoses and feeling safe to send patients home. Then with other 15%, we'd either admit them to the hospital or take them to the operating room for a more thorough examination."

Dr. Larry Demco: "What is the advantage of doing a laparoscopy under local in the emergency room versus an ultrasound or a CT scan?"

Dr. Jay Redan: "Usually the radiologist cannot give you a definitive pathologic diagnosis after an ultrasound or CT scan. By doing the scope, you have direct visualization as to the exact disease process, and you can then initiate exact treatment as far as empiric therapy, as you would with ultrasound or CT scan."

Dr. Larry Demco: "That sounds like a new place for laparoscopy. Do you think it has other uses in other parts of the hospital, the ICU for example?"

Dr. Jay Redan: "Absolutely. ICU examination is becoming popular, especially with Dr. Fowler, with critically ill patients where you don't want to be transporting these patients to the Cat Scan Department, Ultrasound Department, or Angiography Suite. We are at the bedside - you can make a definitive diagnosis regarding their acute disease process."

Dr. Larry Demco: "Jay, it's nice to see that laparoscopy has moved out of the traditional spot of the operating room and into other areas to help speed diagnosis, confirm our suspicions, and to direct proper therapy. I'd like to thank you for your time. See you later."

Dr. Jay Redan: "Thank you."

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