Gasless laparoscopy-assisted colorectal surgery

Background: Laparoscopy has gained wide acceptance as a treatment modality in a variety of colonic and rectal disorders. Currently, most laparoscopic procedures are performed using a carbon dioxide (CO2) pneumoperitoneum, whi ch can lead to cardiopulmonary loading and subsequent complications. The ob ject of this study was to assess the feasibility of gasless laparoscopy-ass isted colorectal surgery (GLACS) as an alternative method. Methods: Patients with benign colonic lesions were enrolled in the study. T he operative field was exposed with a subcutaneous wire lifting system. A s mall incision, similar to5 cm in length, was made early in the operation. T he surgeon operated through the trocar ports and this incision using both l aparoscopic and conventional instruments. The cardiopulmonary responses of the patients were monitored continuously during the operation. Results: Fifteen consecutive patients underwent GLACS. In two patients (13. 3%), conversion to open surgery was necessary. The exposure and ease of the procedure were acceptable. However, when the patients were stratified into hemicolectomy and sigmoidectomy groups, GLACS scored more favorably in the sigmoidectomy group. There were no operative deaths. One minor complicatio n developed postoperatively. All of the patients recovered uneventfully, wi th return of bowel function in 2.8 +/- 0.1 days. The mean postoperative hos pital stay was 6.4 +/- 0.4 days. The cardiac and pulmonary status of the pa tients remained stable during the operation. Conclusion: Gasless laparoscopy-assisted colorectal surgery is technically feasible; thus, it provides an alternative means for the performance of min imal-access surgery.