BACKGROUND: Laparoscopic technique has been applied to a variety of colonic
and rectal operations, generally using carbon dioxide insufflation (CDI),
However, CDI is inevitably associated with cardiopulmonary loading and can
cause complications. The objective of this study was to determine the feasi
bility of gasless laparoscopic colonic surgery.
METHODS: The abdominal wail was lifted up using an originally designed retr
actor, A small incision, 3 to 5 cm in length, was made at the start of the
operation. The surgeon operated through this incision using both convention
al and laparoscopic instruments.
RESULTS: Operations were undertaken in 67 patients. In 6 patients (9%), con
version to open surgery was necessitated. In the remaining 61 patients, ope
rations were completed with gasless laparoscopically assisted technique. Fo
ur reoperations (7%) were performed because of postoperative bleeding, anas
tomotic rotation, anastomotic stricture, and transmesenteric hernia. Fifty-
three patients with colonic cancer were operated on with potentially curati
ve intent. Of these, 1 (2%) developed hepatic recurrence during the mean fo
llow-up period of 23.8 months, There was no port site recurrence.
CONCLUSIONS: Gasless laparoscopic colonic surgery is technically feasible.
CDI is not necessary to perform minimal access surgery. (C) 1999 by Excerpt
a Medica, Inc.