Since laparoscopic cholecystectomy has been performed by P. Mouret in 1987, laparoscopic surgery progressively developed because of its successful application in various intraperitoneal procedures. Pneumoperitoneum using CO2 gas was essential in
maintaining the exposure of operative field, but is may cause metabolic and hemodynamic changes as well as shoulder pain.
Mechanical abdominal retraction was designed initially for minimizing the side effects of CO gas. With the development of lifting devices, gasless laparoscopic sugery was possible with a various potential benefits in the abdominal procedures,
compared
with CO2 gas method.
We investigated the adequacy of exposure, the safety of operation, and the application of conventional instruments (used in open surgery) in gasless laparoscopic surgery. From Mar. 1995 to Jun. 1995, gasless laparoscopic surgery was performed in
15
randomized patients with informed consent. 'Laparo-lift of Origin Medsystem' was used for the lifting of abdominal wall. 8 Women & 7 men(mean age 46, range 37~80) participated in study.
5 cholecystectomies, 9 inguinal herniorrhaphies and 1 segmental colectomy were pertormed with the lapara-lift. A fan shaped retractor was placed in abdomen through a small incision at the umbilicus. After insertion the retractor was attached to
an
electromechanical lifting arm that was attached to the operating table with 30 pounds(13.6kg, 15mmHg of pneumoperitoneum) of lift. Laparoscopy was inserted in this site and operation was done under adequate visualization of peritoneal cavity. As
we
gained more experience. Conventional instruments were used in combination with standard laparoscopic instruments. The adequate exposure o the field was obtained even with continuous suctioning. In 14 out of total 15 cases, gasless laparoscopic
surgery
was successful. Conversion to pneumoperitoneum was done in only one cholecystectomy due to inadequate exposure. Average duratoin of operation was 80min in cholecystectomies and 70min in inguinal herniorrhaphies. There was no difference in the
length of
hospitalization between gasless surgery and pneumoperitoneum method. Average hospital stay was 4.4 days in cholecystectomies and 4.0 days in herniorrhaphies. We observed 3 cases of mild abdominal pain at lifting site with no cases of shoulder
pain.
One
wound infection was occured in herniorrhaphy.
In conclusion, the application of gasless laparoscopic surgery will be expanded in the future because the adequate exposure of the operative field can be done easily with its safety. It also can be done in patients in whom pneunoperitoneum is
impossible
to obtain such as pregnant patients and patients with cardiopulmonary dysfunction. But it requires further experience and continued researches.
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