GASLESS LAPAROSCOPY - WHY AND HOW

The pneumoperitoneum, generally used for all laparoscopic procedures, can lead to specific disadvantages and result in complications, and re presents a restriction of the surgeon's freedom of movement. Alternati ve methods to create sufficient abdominal exposure without pneumoperit oneum have been proposed all over the world. After a description of th e most popular solutions, we describe our first experiences with an el ectromechanical retractor system for laparoscopic surgery. A fan forme d wall retractor, which is attached to an electric lift-arm, is introd uced into the abdominal cavity. After raising the abdominal wall, the laparoscopic procedure can be started without the technical and physio pathological problems which may occur using a pneumoperitoneum. In thi s way we performed gasless laparoscopic surgery on 121 patients: chole cystectomy (n = 78), abdominal exploration for NSAP (n = 6) or tumour staging (n = 12), fenestration of liver cysts (n = 7) and appendectomy (n = 18). In this gasless laparoscopic procedure, simple valveless tr ocars and instruments can be used. During anaesthesia, neither an incr eased ventilation nor increased ventilation pressure are necessary.