AI Article Synopsis
- The study aimed to evaluate a retractor system that allows laparoscopic surgery without the need for pneumoperitoneum, assessing its effectiveness in using standard surgical tools during minimally invasive procedures.
- The research was conducted at a university-affiliated hospital, involving 58 laparoscopic procedures on a diverse group of 58 patients with various trauma and elective conditions.
- Results indicated that gasless laparoscopy was effective in most cases, being able to replace traditional celiotomy in a majority of trauma patients, and provided good surgical exposure while allowing for the use of conventional instruments, suggesting potential benefits and further improvements for this technique.
Article Abstract
Objective: To assess the capability of a retractor system that permits laparoscopic surgery without pneumoperitoneum and to determine if the system facilitates the use of conventional surgical instruments during minimally invasive surgery.
Design: Prospective evaluation and data collection with review.
Setting: University-affiliated county hospital.
Patients: Twenty-nine male and 29 female subjects evaluated prospectively via 27 trauma-related and 31 elective procedures.
Methods: Fifty-eight laparoscopic procedures were performed between July 1992 and February 1993 with a system consisting of an intra-abdominal fan retractor and an electrically powered mechanical arm using conventional surgical and laparoscopic instruments.
Results: Gasless laparoscopy was used in the evaluation of 27 patients with abdominal trauma (11 gunshot wounds, 11 stab wounds, and five blunt injuries). The need for celiotomy was obviated in 20 (74%) of 27 cases. Three enterotomies, two diaphragmatic lacerations, and one gastric perforation were repaired with conventional instruments. Gasless laparoscopic techniques were also used in cholecystectomy (n = 26), diagnostic laparoscopy (n = 3), and appendectomy (n = 2). Exposure similar to that obtained by pneumoperitoneum was obtained in 30 (97%) of 31 cases. One major (trocar tip enterotomy) and two superficial wound infections occurred in this group. The ability to use conventional surgical instruments was advantageous in several cases.
Conclusions: Comparable exposure was achieved in this cohort of patients with gasless laparoscopy. The use of conventional surgical instruments provides an advantage with this technique. Further improvements in abdominal wall lift systems and modification of existing surgical instruments may expand the role of gasless laparoscopy.
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| http://dx.doi.org/10.1001/archsurg.1993.01420220022003 | DOI Listing |
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