Paolucci V, Schaeff B, Gutt C, Encke A
Klinik für Allgemeinchirurgie, Johann-Wolfgang-Goethe-Universität Frankfurt/Main.
Zentralbl Chir. 1994;119(6):383-7.
The pneumoperitoneum as a precondition of laparoscopic procedures represents a restriction of the surgeons freedom of movement and causes rare but typical complications. In July 1993 we started doing laparoscopic cholecystectomy without using a pneumoperitoneum. Under direct vision and digital control the retractor blades are introduced into the abdominal cavity via minilaparotomy. The retractor is attached to an electrically powered mechanical arm and raised. The scope is introduced through the same access and the laparoscopic cholecystectomy can be performed using the established technique without instilling a pneumoperitoneum. Both conventional and laparoscopic surgical instruments were introduced through valveless trocars and unlimited suction without loss of gas and exposure is possible. Metabolic and hemodynamic alterations associated with the intraperitoneal insufflation of carbon dioxide are omitted. So far we did gasless laparoscopic cholecystectomy in 22 patients. We didn't see any related complications. Four times we had to change the surgical procedure. In comparison to the traditional laparoscopic cholecystectomy with a CO2-pneumoperitoneum the results of the first gasless procedures demonstrate possible advantages.
气腹作为腹腔镜手术的一个前提条件，限制了外科医生的活动自由度，并会引发罕见但典型的并发症。1993年7月，我们开始在不使用气腹的情况下进行腹腔镜胆囊切除术。在直视和手指控制下，通过迷你剖腹术将牵开器叶片置入腹腔。牵开器连接到电动机械臂上并升起。通过同一通道插入内镜，不注入气腹就可以使用既定技术进行腹腔镜胆囊切除术。传统和腹腔镜手术器械都通过无阀套管插入，可进行无气体损失的无限制吸引，且能实现暴露。省略了与二氧化碳腹腔内充气相关的代谢和血流动力学改变。到目前为止，我们已为22例患者实施了无气腹腔镜胆囊切除术。我们未见到任何相关并发症。有4次我们不得不更改手术方式。与传统的二氧化碳气腹腹腔镜胆囊切除术相比，最初的无气手术结果显示出可能的优势。
