Gasless laparoscopy in abdominal surgery

Abstract

Pneumoperitoneum, as a necessary precondition of laparoscopic procedures, represents a restriction of the surgeon's freedom of movement and can lead to rare but typical complications. We describe our first experiences with laparoscopic surgery without using pneumoperitoneum. Under direct vision and digital control a fan-formed wall retractor, which is attached to an electric lift arm, is introduced into the abdominal cavity. After raising the abdominal wall, the scope is introduced through the same access and the laparoscopic procedure can be started without the technical and physiopathological problems which may occur using a pneumoperitoneum. In this gasless laparoscopic procedure, simple valveless trocars and instruments can be used. Furthermore, an unlimited suction can be obtained without a loss of exposure. During anesthesia, neither increased ventilation nor increased ventilation pressure is necessary, and the surgeon has increased freedom of action. Not only special laparoscopic instruments, but the conventional instruments, used in open surgery, can also be employed in gasless laparoscopy. In this way we performed gasless laparoscopic surgery on 54 patients: cholecystectomy (n = 37), abdominal exploration for NSAP (n = 5) or tumor staging (n = 4), fenestration of liver cysts (n = 5), and appendectomy (n = 3). We did observe three wound infections as related complications. Six times, we had to change the surgical procedure. Compared to the traditional procedure with a CO2 pneumoperitoneum, the results of the first gasless procedures demonstrate potential advantages.

Port-Site Metastases: Fact or Fiction?

“…The first evidence began to appear in the literature in the early 1990s when O'Rourke and Gleason published the first data on this subject in The Lancet and the American Journal of Obstetrics and Gynecology, respectively, in 1993 [3]. These first studies were followed in quick succession by other publications from various specialties where laparoscopic surgery is practiced, confirming the first observations [3,[6][7][8]. The description of tumor cell dissemination in association with laparoscopic surgery runs from the very outset like a leitmotif through the literature (table 2), but surprisingly did at first not receive due recognition.…”

A Study to Evaluate Role of Intraperitoneal Saline Wash for Shoulder Tip Pain Reduction after Laparoscopic Cholecystectomy

“…Thus low pressure pneumoperitoneum and removal of insufflated gas or use of gas drains [12,24,25]. Use of N 2 O, Helium or Argon in place of CO 2 [26] bupivacaine infusion under right hemidiaphragm [27] warm and humified gasless laparoscopy [34]. And in intraperitoneal instillation of normal saline [22,35,36] are some methods that have been studied for reduction of abdominal and shoulder pain after laparoscopic cholecystectomy.…”

Single Incision Gasless Laparoscopic Myomectomy

“…For instance, pneumoperitoneum in addition to causing physiological changes has small but definite complications. 10 Several animal studies have documented problems that are associated with use of carbon dioxide for insufflation.…”