GASLESS LAPAROSCOPIC CHOLECYSTECTOMY

The pneumoperitoneum as a precondition of laparoscopic procedures repr esents a restriction of the surgeons freedom of movement and causes ra re but typical complications. In July 1993 we started doing laptroscop ic cholecystectomy without using a pneumoperitoneum. Under direct visi on and digital control the retractor blades are introduced into the ab dominal cavity via minilaparotomy. The retractor is attached to an ele ctrically powered mechanical arm and raised. The scope is introduced t hrough the same access and the laparoscopic cholecystectomy can be per formed using the established technique without instilling a pneumoperi toneum. Both conventional and laparoscopic surgical instruments were i ntroduced through valveless trocars and unilimited suction without los s of gas and exposure is possible. Metabolic and hemodynamic alteratio ns associated with the intraperitoneal insufflation of carbon dioxide are omitted. So far we did gasless laparoscopic cholecystectomy in 22 patients. We didn't see any related complications. Four times we had t o change the surgical procedure. In comparison to the traditional lapa roscopic cholecystectomy with a CO2-pneumoperitoneum the results of th e first gasless procedures demonstrate possible advantages.