The gasless laparoscopic cholecystectomy.

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.