GASLESS LAPAROSCOPY IN ABDOMINAL-SURGERY

Pneumoperitoneum, as a necessary precondition of laparoscopic procedur es, represents a restriction of the surgeon's freedom of movement and can lead to rare but typical complications. We describe our first expe riences with laparoscopic surgery without using pneumoperitoneum. Unde r 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 thr ough the same access and the laparoscopic procedure can be started wit hout the technical and physiopathological problems which may occur usi ng a pneumoperitoneum. In this gasless laparoscopic procedure, simple valveless trocars and instruments can be used. Furthermore, an unlimit ed suction can be obtained without a loss of exposure. During anesthes ia, neither increased ventilation nor increased ventilation pressure i s necessary, and the surgeon has increased freedom of action. Not only special laparoscopic instruments, but the conventional instruments, u sed in open surgery, can also be employed in gasless laparoscopy. In t his way we performed gasless laparoscopic surgery on 54 patients: chol ecystectomy(n = 37), abdominal exploration for NSAP (n = 5) or tumor s taging(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.