Laparoscopic cholecystectomy: an approach without pneumoperitoneum.

Diagnostic pneumoperitoneum, which has been considered the first step of any laparoscopic procedure, is no longer an absolute necessity. We devised an alternative to pneumoperitoneum or abdominal insufflation by upward and outward traction on the anterior abdominal wall with a "hanger lifting method" using subcutaneous wiring. Fairly good room was produced intraabdominally, which was enough in which to perform the cholecystectomy procedure. We have successfully performed 40 cases of laparoscopic cholecystectomy with this procedure. No complication was experienced with this method and, moreover, excess instrumentation and complications related to pneumoperitoneum were avoided.