Paolucci V, Schaeff B, Gutt C N, Encke A
Department of General Surgery, Johann-Wolfgang-Goethe University, Frankfurt, Germany.
Endosc Surg Allied Technol. 1995 Feb;3(1):76-80.
The pneumoperitoneum, generally used for all laparoscopic procedures, can lead to specific disadvantages and result in complications, and it furthermore represents a restriction of the surgeon's freedom of movement. In July, 1993 we started doing laparoscopic surgery without the pneumoperitoneum. Under direct vision and digital control, a fan-shaped wall retractor, which is attached to an electric lift arm, is introduced into the abdominal cavity. After raising the abdominal wall, the scope is introduced through the same access and the laparoscopic procedure can be started without the technical and pathophysiological problems which may occur when using a pneumoperitoneum. In this gasless laparoscopic procedure, simple valveless trocars and instruments can be used. During anaesthesia, neither an increased ventilation nor an enlarged ventilation pressure is necessary in this way we performed gasless laparoscopic cholecystectomy in 50 patients. We observed 5 wound infections as related complications. We had to change the surgical procedure seven times. The retraction technique creates a sufficient but not optimal exposure to the gallbladder. Intraoperative changes of the instruments, suction and specimen removal appeared easier. Both conventional and laparoscopic surgical instruments were introduced through the valveless trocars. Our experience demonstrates the practicability of this technique and potential advantages.
气腹通常用于所有腹腔镜手术，会导致特定的缺点并引发并发症，而且还限制了外科医生的活动自由度。1993年7月，我们开始进行无气腹腹腔镜手术。在直视和手指控制下，将连接到电动升降臂的扇形腹壁牵开器引入腹腔。抬起腹壁后，通过同一通道插入腹腔镜，即可开始腹腔镜手术，而不会出现使用气腹时可能出现的技术和病理生理问题。在这种无气腹腔镜手术中，可以使用简单的无阀套管针和器械。麻醉期间，无需增加通气量或增大通气压力。通过这种方式，我们为50例患者实施了无气腹腔镜胆囊切除术。我们观察到5例伤口感染作为相关并发症。我们不得不7次更改手术方式。牵开技术可充分但并非最佳地暴露胆囊。术中器械的更换、吸引和标本取出似乎更容易。传统和腹腔镜手术器械均通过无阀套管针插入。我们的经验证明了该技术的实用性和潜在优势。
