LAPAROSCOPIC SURGERY WITHOUT PNEUMOPERITONEUM - A PRELIMINARY-REPORT

Laparoscopic surgery using pneumoperitoneum to create an operating fie ld is known to have cardiopulmonary side effects. Conventional laparos copic techniques require operating in a sealed environment. In July 19 92, we initiated an investigation of the use of an electric-powered ab dominal-wall lifter to expose an operating field. In our preliminary s tudy, we have successfully completed 16 of 20 cases (80%) using this m ethod of exposure. One trocar-related small-bowel injury was recognize d immediately and repaired uneventfully. Two patients with dense adhes ions made laparoscopic cholecystectomy impossible. One case of laparos copic cholecystectomy was completed by conversion to pneumoperitoneum. Conventional instruments can be used through small incisions. Digital examination of abdominal contents can be achieved through the periumb ilical incision or through other small incisions with the guidance of this retractor; this is superior to pneumoperitoneum since the surgeon can use more than just visual examination of intraabdominal pathology in laparoscopic surgery.