Survey of Minimally Invasive Surgery Usage for Traumatic Injuries among High-income and Low-middle-income Countries

Objective: Laparoscopy and thoracoscopy are becoming common tools for diagnosis and subsequent surgical intervention in selected trauma patients.The use of minimally invasive surgery (MIS) in trauma, especially in more limited-resource settings, is relatively unknown.The aim of this survey was to describe surgeons' perspectives regarding the usage of MIS as well as its indications and barriers worldwide in both highincome countries (HIC) and low-middle-income countries (LMIC).Methods: A voluntary and anonymous survey, exempt from IRB approval, was created using a secure REDCap server and distributed to surgeons.The survey questions were developed among trauma surgeons across several different countries and were translated into three different languages (English, Spanish, and Portuguese) by native speakers.Results: A total of 211 responses were obtained (61 English, 70 Portuguese, 80 Spanish) from 22 different countries.129 (61%) of respondents were from LMIC.Most respondents were male (81 vs 19%), with no additional trauma fellowship training (54%), working in a public hospital (65.9%).Most stated that laparoscopy was available (74%) and was considered for traumatic injuries (73%) in selected cases.Laparoscopy was considered primarily for assessing the intra-abdominal cavity (89%)-in particular, for suspected diaphragmatic injury (75%), hollow viscus injuries (77%), and assessing solid organ injury (82%).About 46% of respondents utilized video-assisted thoracic surgery (VATS), primarily for retained hemothorax (50%).Most respondents (83%) believe that MIS techniques should be used in trauma.Potential benefits mentioned included improvement in trauma outcomes (90%), superiority to imaging for diagnosis (73%), reduced pain (82%), shorter hospital stay (85%), less infection (70%), and patient satisfaction (58%).The main barriers reported included surgeon expertise (50%), operating room staff training (33%), and equipment availability (37%).Only 5% of the surgeons mentioned facing no barriers to MIS use. Conclusion:A worldwide survey found that most surgeons use MIS in trauma.Barriers to implementation in limited-resource centers included surgeon expertise, operating room staff experience, and equipment availability.