SYSTEMS AND INSTRUMENTS FOR LAPAROSCOPIC SURGERY WITHOUT PNEUMOPERITONEUM

The insufflation of carbon dioxide into the peritoneal cavity is a rou tine technique of abdominal exposure in laparoscopic surgery. Because of adverse physiological effects and technical disadvantages of the pn eumoperitoneum, alternative methods of abdominal wall lifting have bee n explored recently. Two groups of retraction systems exist: intraabdo minal lifting and subcutaneous lifting of the abdominal wall. Some sys tems require additional pneumoperitoneum, because the extent of intraa bdominal exposure is not sufficient. Other systems are working complet ely without gas insufflation. Two systems combine abdominal wall lifti ng with pressure on the internal organs. Every method allows the use o f standard laparoscopic instruments, which originally were designed fo r a regular pneumoperitoneum. The use of a low-pressure pneumoperitone um in combination with mechanical augmentation of the peritoneal cavit y reduces physiological disadvantages of laparoscopy. But technical ad vantages, such as combination of laparoscopic and open techniques, can be realized only without gas insufflation. Conventional instruments h ave been designed to fit the ergonomical needs of isopneumic laparosco py and to be employed with simple valveless cannulae.