The authors reports their experience on 50 patients treated with laparoscopic approach for hepatic trauma. In the Italian Report on 2515 cases of hepatic trauma, 989 (39.4%) underwent NOM (Non Operative Management) and 1525 (60.6%) underwent at OM (Operative Management). Of these, 50 underwent at laparoscopic approach, with 14 conversions to laparotomy.

In 29 cases the laparoscopic approach showed a spontaneous hemostasys and we have positioned an abdominal drainage; in 7 cases performed a laparoscopic hemostasys. No mortality and only one major complication: a biliary fistula.

In our series on 2515 cases, 133 at the time of the surgical exploration not showered bleeding. The hemodynamic stability is essential to the laparoscopic approach. The indications are the increasing bleeding, the border clinical situation between the NOM (Non Operative Management) and OM (Operative Management). The laparoscopic approach not is indicated without hemodynamic stability, in the brain injuries with not treated hypertension, in the hepatic trauma upper III O.I.S. degree, in the demonstrated injuries of the cava and hepatic veins. For us, the laparoscopic approach in the hepatic trauma is a small window between NOM and OM.