Gasless laparoscopy for benign gynecological diseases using an abdominal wall-lifting system

Abstract

Abstract:Objectives: The use of gasless laparoscopy with an abdominal wall-lifting device for benign gynecological diseases was compared to conventional laparoscopy with CO 2 pneumoperitoneum. Methods: From February 2007 to July 2007, 76 women with uterine and/or adnexal benign diseases and candidates for laparoscopic surgery were recruited in this study. Thirty-two women underwent gasless laparoscopic surgery and 44 women underwent pneumoperitoneum laparoscopic surgery. Results: Diverse pathologies, including adnexal cyst, uterine myoma and ectopic pregnancy, were treated successfully with gasless laparoscopic surgery. Compared with the patients in the pneumoperitoneum group, the similar hospital stay (P=0.353) and intraoperative blood loss (P=0.157) were observed. However, the mean operative time in the gasless group was significantly longer than that in the pneumoperitoneum group (P=0.003). No severe intraoperative or postoperative complications were found in either group, except for one case of laparotomic conversion in the pneumoperitoneum group due to dense pelvic adhesions. The total hospital charges were significantly less in the gasless group than in the pneumoperitoneum group (P=0.001). In 38 cases of ovarian cyst resection, the mean operative time in the gasless group remained longer than that in the pneumoperitoneum group (P=0.017). The total hospital charges were also significantly less in the gasless group than in the pneumoperitoneum group (P<0.001). Conclusion: Our preliminary results demonstrated that the laparoscopic procedure using the gasless technique was a safe, effective method to treat benign gynecological diseases. Moreover, it was easy to master. As a minimally invasive treatment, gasless laparoscopic surgery provides a good choice to patients in the undeveloped regions in China without increasing the patients' and the government's burden significantly.

Hybrid approach of retractor-based and conventional laparoscopy enabling minimally invasive hysterectomy in a morbidly obese patient: Case report and review of the literature

“…This combination provides good surgical exposure without adverse cardiovascular consequences and was applied in the present case (4). According to current data, there are no significant differences between conventional and gasless laparoscopy regarding blood loss and hospital stay (5,7). Some authors even reported less intraoperative blood loss and less postoperative drainage volume (17).…”

“…In contrast to conventional laparoscopic instruments, retractorbased laparoscopy can be performed using conventional surgical instruments and valveless trocars using small incisions (5,13). Intraoperative change of surgical instruments through valveless trocars, suction and removal of specimens appears easier in gasless laparoscopy (14,15).…”

“…Furthermore regarding the pneumoperitoneum, in trauma patients there is a risk of CO 2 embolism, and of tumor dissemination in patients undergoing laparoscopic surgery for cancer (4). In particular in obese patients, ventilation is reduced due to pneumoperitoneum and due to the Trendelenburg position (5). Gasless laparoscopy, usually executed with the help of a retractor system exerting its effects through gravity, is performed without pneumoperitoneum and thus can be performed on high-risk patients with poor cardiorespiratory reserve or on pregnant women (4,6,7).…”

Gasless Laparoscopy versus Conventional Laparoscopy in Uterine Myomectomy: A Single-Centre Randomized Trial

“…Gasless laparoscopic surgery has the additional merit of minimal invasiveness and it is not subject to complications such as subcutaneous emphysema, hypercapnia and gas embolism. 19 It has been reported that the postoperative recurrence rate for traditional laparoscopic myomectomy is higher than that for gasless laparoscopy. 20 A recent report found the recurrence rate of gasless laparoscopy myomectomy was 11.7% after 1 year, 36.1% after 3 years, 52.9% after 5 years and 84.4% after 8 years.…”

The Management of Gynecological Laparoscopy Complications: Review

“…These gasless procedures may be of particular use in benign gynaecological conditions and are easier to master than insufflation-based techniques, making them an attractive option in, for example, less developed areas. 61 The potential to carry out the procedure under regional anaesthesia and the avoidance of hypercarbia and increased abdominal pressure due to CO 2 insufflation also make this technique particularly suitable during pregnancy. 62 …”