Modified Technique of Gasless Laparoscopic Cholecystectomy in a Developing Country: A 5-Year Experience

Abstract

Background: Concerns and disadvantages associated with pneumoperitoneum have led surgeons to search for alternative techniques of exposure in laparoscopic surgery. We devised a modified technique of gasless laparoscopic cholecystectomy based on the concept of mechanical retraction of the abdominal wall. Patients and Methods: 337 males and 663 females, mean age 52 (7–87) years and mean weight 68 (28–126) kg, with gallstone disease and subjected to this technique were evaluated retrospectively (1992–1997). Towel clips were applied at 3 points on the abdominal wall and it was lifted without creating a pneumoperitoneum. A single surgical team specialized and experienced in biliary surgery performed all the surgeries. Results: Of 1,000, 46 patients weighing more than 85 kg required a combination of mechanical abdominal wall retraction and minimal pressure pneumoperitoneum (5 mm Hg). The conversion rate was 6% but none were related to limitations of the technique. Technique-related morbidity was minimal. No common bile duct or visceral injury was recorded and mortality was 0%. Conclusion: Gasless laparoscopic cholecystectomy is a feasible, safe and effective alternative to the pneumoperitoneum technique. It probably costs less and is therefore more useful in developing countries. However, it has limitation in overweight patients who are infrequently encountered in our population.

Vacuum-assisted abdominal wall lift for minimal-access surgery: a porcine model study

“…The limiting factors of the vacuum lift are the elasticity of the body wall (which will remain common no matter what type of lifting mechanism is used), the shape and size of the vacuum shell, and the vacuum applied. This is different from all existing mechanical lift devices and techniques, which provide a tenting rather than the required domelike symmetric lift [1,2,9,13].…”

“…This acceptance is despite the documented deleterious effects of CO 2 [7,8,[10][11][12]. This acceptance of CO 2 insufflation is a testament to the shortcomings of previously described gasless abdominal wall lift methods, which have had poor acceptance for various reasons [2,9,13].…”

Effectiveness of Laparoscopic Surgery for Gallstones and Common Bile Duct Lithiasis: a Systematic Overview

“…Several variants of LC have been described, but evidence about their effectiveness is scarce (Low quality evidence). On the other hand, there is no evidence of major complications with outpatient LC (Low quality evidence) (Al-Ghnaniem, 2003;Koc, 2003;Harling, 2000;SIGN, 2004;Ladocsi, 1997;Millat, 1997;Thornton, 2002;Kitano, 1993;Barczynski, 2004;Nande, 2002;Trichak, 2003;Novitsky, 2005;Lai, 2003;Zhou, 2006;Corbitt, 1991;Bordelon, 1993;Lane GE, 1993;Janssen, 2003;Cengiz, 2005;Edelman, 1995;Shekarriz, 2003;Bencini, 2003;Yano, 2003;Verma, 2006;Grace, 1991;Martinez Vieira, 2004;Lau, 2002;Pattillo, 2004;Bueno Lledo, 2006).…”

“…Routine intraoperative aspiration of gallbladder during laparoscopic cholecystectomy seems to be associated to less postoperative morbidity proportion respect to traditional LC (Calik, 2007). Undertaking LC without pneumoperitoneum is one of the multiple variants described for LC and is supported by two low quality RCTs (Kitano, 1993;Barczynski, 2004) and also by a retrospective case series (Nande, 2002). The reduction in the number of access ports (Trichak, 2003) and the use of 'mini-laparoscopy' and 'mini-instruments' is upheld by medium-quality RCTs and by a prospective case series (Nuzzo, 2005;Novitsky, 2005;Lai, 2003).…”

Colecistectomía laparoscópica durante la gestación

“…Algunos autores usan presiones intraabdominales mínimas y una posición de decúbito lateral izquierdo con una mínima posición de anti-Trendelenberg (4). Algún estudio demuestra que se puede trabajar con presiones de aire mínimas, pero el riesgo de reconversión es mayor (5). Se recomienda colocar primero un trocar epigástrico (6).…”