Shokei Matsumoto

Digital video recording in trauma surgery using commercially available equipment

IntroductionAlthough videos of surgical procedures are useful as an educational tool, the recording of trauma surgeries in emergency situations is difficult. We describe an inexpensive and practical shooting method using a commercially available head-mounted video camera.MethodsWe used a ContourHD 1080p Helmet Camera (Contour Inc., Seattle, Washington, USA.). This small, self-contained video camera and recording system was originally designed for easy videography of outdoor sports by participants.ResultsWe were able to easily make high-quality video recordings of our trauma surgeries, including an emergency room thoracotomy for chest stab wounds and a crush laparoptomy for a severe liver injury.ConclusionThere are currently many options for recording surgery in the field, but the recording device and system should be chosen according to the surgical situation. We consider the use of a helmet-mounted, self-contained high-definition video camera-recorder to be an inexpensive, quick, and easy method for recording trauma surgeries.

Predictive value of a flat inferior vena cava on initial computed tomography for hemodynamic deterioration in patients with blunt torso trauma.

BACKGROUND We aimed to investigate the value of the diameter of the inferior vena cava (IVC) on initial computed tomography (CT) to predict hemodynamic deterioration in patients with blunt torso trauma. METHODS We reviewed the initial CT scans, taken after admission to emergency room (ER), of 114 patients with blunt torso trauma who were consecutively admitted during a 24-month period. We measured the maximal anteroposterior and transverse diameters of the IVC at the level of the renal vein. Flat vena cava (FVC) was defined as a maximal transverse to anteroposterior ratio of less than 4:1. According to the hemodynamic status, the patients were categorized into three groups. Patients with hemodynamic deterioration after the CT scans were defined as group D (n = 37). The other patients who remained hemodynamically stable after the CT scans were divided into two groups: patients who were hemodynamically stable on ER arrival were defined as group S (n = 60) and those who were in shock on ER arrival and responded to the fluid resuscitation were defined as group R (n = 17). RESULTS The anteroposterior diameter of the IVC in group D was significantly smaller than those in groups R and S (7.6 mm ± 4.4 mm, 15.8 mm ± 5.5 mm, and 15.3 mm ± 4.2 mm, respectively; p < 0.05). Of the 93 patients without FVC, 16 (17%) were in group D, 14 (15%) required blood transfusion, and 8 (9%) required intervention. However, of the 21 patients with FVC, all patients were in group D, 20 (95%) required blood transfusion, and 17 (80%) required intervention. The patients with FVC had higher mortality (52%) than the other patients (2%). CONCLUSION In cases of blunt torso trauma, patients with FVC on initial CT may exhibit hemodynamic deterioration, necessitating early blood transfusion and therapeutic intervention.

Routine Head Computed Tomography for Patients in the Emergency Room with Trauma Requires Both Thick- and Thin-Slice Images.

Background. Images of head CT for the supratentorial compartment are sometimes recommended to be reconstructed with a thickness of 8–10 mm to achieve lesion conspicuity. However, additional images of a thin slice may not be routinely provided for patients with trauma in the emergency room (ER). We investigated the diagnostic sensitivity of a head CT, where axial images were 10 mm thick slices, in cases of linear skull fractures. Methods. Two trauma surgeons retrospectively reviewed head CT with 10 mm slices and skull X-rays of patients admitted to the ER that were diagnosed with a linear skull fracture. All patients had undergone both head CT and skull X-rays (n = 410). Result. The diagnostic sensitivity of head CT with a thickness of sequential 10 mm was 89% for all linear skull fractures but only 56% for horizontal fractures. This CT technique with 10 mm slices missed 6% of patients with linear skull fractures. False-negative diagnoses were significantly more frequent for older (≥55 years) than for young (<15 years) individuals (p = 0.048). Conclusions. A routine head CT of the supratentorial region for patients in the ER with head injuries requires both thick-slice images to visualize cerebral hemispheres and thin-slice images to detect skull fractures of the cranial vault.

Transarterial Embolization Affects Recovery in Nonoperative Management of Severe Blunt Hepatic Injuries: A Retrospective Study

Introduction: Transarterial embolization (TAE) has been used as an essential technique in the nonoperative management (NOM) of severe blunt hepatic injuries (BHI) but has a possible risk of tissue ischemia and necrosis, which may affect hepatic recovery. The injured liver tissue gets encapsulated and absorbed by intact liver tissue; therefore, the healing process requires the formation of a wall surrounding the injured tissue. In this study, we determined the impact of TAE on the hepatic healing process.Patients and methods: We reviewed hemodynamically stable patients (n=35; males, 23; females, 12; mean age, 32 years), admitted to our hospitals over a 10-year period, who underwent NOM of severe BHI (American Association for the Surgery of Trauma Organ Injury Scale, grades IV and V). Data collected included demographic information, serial CT findings, severity of hepatic injuries showing lacerations (Couinauds liver segment classification), TAE performed for active hepatic bleeding, and the amount of hemoperitoneum. Extrahepatic factors were evaluated using the Abbreviated Injury Scale for injuries to the head, face, thorax, and extremities. Time taken by injured segments to encapsulate was individually obtained from serial CTs. Cox regression and Kaplan-Meier analyses were used to identify risk factors associated with delayed healing among the hepatic and extrahepatic factors mentioned above.Results: Risk factors were independently and significantly associated with TAE (odds ratio, 2.45; 95% confidence interval, 1.01-5.92; p=0.047). Multivariate analysis indicated that patients who underwent TAE took 2.45-times longer time to attain liver encapsulation than those who did not undergo TAE and that extrahepatic factors did not correlate with the time to encapsulation.Conclusion: TAE for active liver hemorrhage resulted in a delayed recovery from BHI, regardless of extrahepatic factors.

A quick and easy closure technique for abdominal stab wound after diagnostic laparoscopy.

Mandatory laparotomy for patients with abdominal stab wounds (ASWs) not only allows for the early detection of some expected injuries but also results in a higher unnecessary laparotomy rate, longer hospital stays, and increased hospital costs.1,2 Delayed laparotomy, however, increases mortality and morbidity. Therefore, the decision regarding when to operate on a patient with an ASW remains a challenge. Recent reports have demonstrated that diagnostic laparoscopy (DL) is useful for ASWs.3–5 In Japan, more than half of ASW patients are associated with suicide attempts because of psychiatric illnesses or mental disorders.6 Under these circumstances, physical examinations are sometimes unreliable so that DL should be frequently used in these patients. Even if DL prevents unnecessary laparotomy, it remains possible that these ASWs may subsequently develop ventral hernias.7,8 In addition, some cases of ASWs require an extended local wound that is as long as a laparotomy for direct fascial closure. Here, we report the laparoscopic repair of the abdominal wall using an Endoclose suturing device (Covidien, Mansfield, MA) when laparotomy is not needed according to DL.