A RANDOMIZED COMPARISON OF GASLESS LAPAROSCOPY AND CO2 PNEUMOPERITONEUM

Objective: To determine if the theoretic advantages of gasless laparos copy are realized in direct comparison to laparoscopy with pneumoperit oneum. Methods: Fifty-seven patients undergoing laparoscopic surgery c hose to participate in this trial and were randomized after the induct ion of general anesthesia. Twenty-nine of the 57 patients were randomi zed to the pneumoperitoneum group. Of the 28 patients in the gasless g roup, six were converted to pneumoperitoneum because of inadequate exp osure. The adequacy of exposure and ease of surgery were assessed with a subjective score, and the times to exposure and for incision closur e were recorded. Various anesthetic factors were measured. Patients co mpleted an analog pain score in the recovery area and for the first 5 postoperative days. Analgesic and antiemetic use also was recorded, as was the number of days to return to normal activity. Results: Times t o achieve exposure and close incisions were longer, and exposure and e ase of surgery were worse in the gasless group. Patients in the gasles s group had lower diastolic blood pressure, minute ventilation, peak i nspiratory pressures, and end tidal pCO(2). There were no differences in body temperature, systolic blood pressure or heart rate, postoperat ive pain scores, analgesic or antiemetic use, or times to hospital dis charge or return to activity between the groups. Conclusion: Performin g laparoscopy using the Laparolift device compromised surgical exposur e and thus increased technical difficulty. Patients realized no benefi ts from its use in terms of postoperative discomfort or return to acti vity. Eliminating the pneumoperitoneum allowed lower minute ventilatio n and peak inspiratory pressures, and end tidal pCO(2) was lower. Alth ough the concept of gasless laparoscopy holds appeal, the current prot otype is not well-suited for infertility procedures. ((C) 1997 by The American College of Obstetricians and Gynecologists).