The new techniques of gynaecologic laparoscopy. Gasless, open Hasson, optic trocar

Background, New techniques of laparoscopy: gasless, open Hasson, optic troc ars allow to avoid the risks of vessel and bowel injuries. The objective of this study was to evaluate the capability of a retractor system as an alte rnative to conventional technique without pneumoperitoneum and to assess if the system facilitates the use of conventional surgical instruments during gynaecological surgery, Methods. Design: Prospective evaluation, Setting: University-affiliated cou nty hospital. Patients: Gasless laparoscopy surgery was performed on 49 pat ients between December 1995 and July 1996 with a retractor system without p neumoperitoneum consisting of an intrabdominal retractor using conventional surgical and laparoscopic instruments and to enable a simultaneous vaginal approach. Results. Gasless laparoscopy was successful in 44 (90%) of cases, A simulta neous vaginal approach was used in one third of indications including vagin al myomectomy and laparoscopic assisted hysterectomy, Conversion to laparot omy was required in 5% of cases, Mean procedure duration was 90 minutes and mean hospitalisation time was 5.7 days, Conclusions. The introduction of new techniques of laparoscopy: gasless, op en Hasson, optic trocars has broadened the application of operative laparos copy, Gasless technique in lieu of conventional laparoscopy can be performe d reliably and safely for most gynaecological indications. The most outstan ding benefit of this method is that it can be combined with a vaginal appro ach which is not possible using a pneumoperitoneum due to gas leakage, The place of gasless laparoscopy will depend on continuing development by instr ument manufacturers; in order to achieve an instrument providing vision as good as that seen with the pneumoperitoneum.