GASLESS LAPAROSCOPY PDF

The diagnosis of acute abdomen in the emergency setting, still remains a challenging problem. In these cases timely diagnosis and management is of great importance, while the anesthetic risk is high. The combination of the risk of an open laparotomy and the relative high likelihood of negative findings when performed, creates the need for a better approach. The alternative actually exists since when Eruheim made the first gasless laparoscopy. The aim of this study is to put back into the spotlight, gasless laparoscopy in the differential diagnosis of acute abdomen and to underline the advantages of this simple, cheap and very useful technique, especially in patients that require prompt diagnosis and have relative or absolute contraindications to general anesthesia or pneumoperitoneum. This study included 49 patients that were managed with gasless laparoscopy for the diagnosis of acute abdomen, from to

Author:Tauk Meztigrel
Country:Cyprus
Language:English (Spanish)
Genre:Science
Published (Last):17 March 2015
Pages:426
PDF File Size:13.24 Mb
ePub File Size:19.80 Mb
ISBN:547-6-73447-125-6
Downloads:5230
Price:Free* [*Free Regsitration Required]
Uploader:Mazugar



The diagnosis of acute abdomen in the emergency setting, still remains a challenging problem. In these cases timely diagnosis and management is of great importance, while the anesthetic risk is high.

The combination of the risk of an open laparotomy and the relative high likelihood of negative findings when performed, creates the need for a better approach.

The alternative actually exists since when Eruheim made the first gasless laparoscopy. The aim of this study is to put back into the spotlight, gasless laparoscopy in the differential diagnosis of acute abdomen and to underline the advantages of this simple, cheap and very useful technique, especially in patients that require prompt diagnosis and have relative or absolute contraindications to general anesthesia or pneumoperitoneum.

This study included 49 patients that were managed with gasless laparoscopy for the diagnosis of acute abdomen, from to Two techniques were used: the mechanical lift of the anterior abdominal wall and the LapVision device. With both techniques used, sample of the intraperitoneal fluid or biopsy could be obtained.

The gasless technique for laparoscopy is an extremely useful mean of diagnosis in emergency conditions, or for patients with contraindications to undergo laparoscopy by pneumoperitoneum. Requiring only local or regional anesthesia, this technique could easily find application in diagnosis and treatment, while avoiding unnecessary laparotomies. Hippokratia , 19 1 : The differential diagnosis of acute abdomen remains a complex clinical issue because, on one hand the patient involved could be already compromised and the time available for diagnosis limited, and on the other hand due to frequent lack of diagnostic means [computed tomography CT , magnetic resonance imaging MRI , ultrasonography US ].

In such cases, diagnostic laparoscopy may solve the differential diagnostic problem. There are, however, patients where pneumoperitoneum is contraindicated head trauma, brain tumors, etc. In these patients, gasless laparoscopy could be a valuable alternative. Gasless laparoscopy is the laparoscopic procedure in which, instead of pneumoperitoneum, the operational space in the abdomen is created by various mechanical means that raise the abdominal wall.

The method is not novel, but is currently revalorized in the above described context, and used more frequently. The idea of gasless laparoscopy belongs to Eruheim who described it in In Muhe achieved the first laparoscopic cholecystectomy without pneumoperitoneum. Currently, this technique is used in emergency surgery, especially in debilitated patients and in gynecological cases with uncertain diagnosis.

Three hospitals were included in this study: Hospital of Obstetrics and Gynecology "I. Sbarcea" of Brasov, Children's Hospital of Brasov and Emergency Hospital Roman, where 49 gasless laparoscopic procedures were performed during the period For these 49 procedures, two methods were used: the mechanical lift of the anterior abdominal wall laparolift and the LapVision system Pajunk GmbH, Geisingen, Germany.

Laparolift can be performed in many ways by instruments that, while fixed to the operating table, raise the abdominal wall 1. We chose a sui-generis alternative, in which an incision is made about 2 cm from the base of the navel, the abdominal wall is afterwards raised with two Kocher clamps and the laparoscope is introduced in the abdominal cavity. Then, the balloon is inflated and a 3. Regarding the anesthesia used in gasless laparoscopy, it can be either regional or local anesthesia. The indications for the procedures are summarized in Table 1.

In total, gasless laparoscopy was performed in 22 patients using the abdominal wall lifting method while in 27 patients using the LapVision system.

Final diagnoses were established in 41 patients and are presented in detail in Figure 1 , while in eight patients no obvious cause was identified or existed. Of these eight cases without diagnosis, five involved multiple trauma with symptoms of acute abdomen, in which we could not identify any pathological findings by gasless laparoscopy.

The other three cases involved intense abdominal pain, in older patients, with severe neurological and cardiological problems, in whom mesenteric ischemia was suspected, but was eventually excluded, without revealing though any obvious cause for the pain. Treatment followed in each case, depended on the diagnosis and is presented on Table 2. Based on our experience and local guidelines applied, gasless laparoscopy is currently in use in our institutions only for diagnostic purposes and this results in managing these cases either with gas laparoscopy or with laparotomy.

It is though under consideration, once our experience is advanced, to use this method for therapeutic applications in the future. Regarding the eight patients in which laparoscopy was inconclusive: three were managed conservatively and further investigations were performed, while in the five cases of multiple injury with abdominal pain, gasless laparoscopy established that the pain was not caused by internal trauma, needed to be treated surgically, allowing in this way conservative management, with good results, thus avoiding unnecessary exploratory laparotomy.

The use of gasless laparoscopy has a number of advantages resulting from the lack of side effects and complications caused by the creation of pneumoperitoneum by CO 2 2.

Regarding the issue of gasless laparoscopic surgery, the available studies in the literature are relatively few and the largest series published are comparable to ours. In a larger study, Paolucci et al 1 studied the gasless method in a group of 54 patients that underwent laparoscopic surgery achieving: 37 cholecystectomies, 5 diagnostic laparoscopies, 3 appendectomies, 5 cystectomy and 4 biopsies of liver metastases. This author and others 1 - 6 used exclusively the laparolift method, with the LapVision variant not being mentioned.

Also a study of Ge et al, in cases of appendectomies performed by gasless laparoscopy showed significantly decreased hospital costs 8. Both gasless systems have the advantage of avoiding general anesthesia, requiring only local or regional anesthesia. Also, both allow the use of any ordinary tools for aspiration and drainage, making the technique cheap and easy to implement. LapVision system has the additional advantage that it does not exert traction on the abdominal wall 9 which results in reduced pain, its flexible trocar can be left in place for drainage, or for the possibility of an easy second look laparoscopy, and additionally the system allows the performance of biopsies through the biopsy channel attached to the trocar.

Gasless laparoscopy performed by both methods has some disadvantages as well. First of all, the view is somewhat inadequate, especially in the lateral and inferior quadrants. Distension of the abdominal wall with the laparolift method is in a pyramid like shape that creates the effect of a tent and most importantly, can be painful In the obese patients or those with a thick abdominal wall, achieving gasless laparoscopy is difficult.

Complications related to the blind insertion of the Veress needle and the first trocar can theoretically be avoided, since the open approach technique is used instead. It has to be mentioned though that neither this technique is free of complications.

Thus in gasless laparoscopy, all described entry related complications can occur. Post-operative complications are commonly related to the abdominal incision and are similar to the complications of classic surgery: parietal hematoma, infection at the incision site and dehiscence. In our study, there were five cases of infection at the site of the incision three cases of pelviperitonitis and two of perforated ulcer and one case of parietal hematoma.

All cases with incision infections were managed by antibiotics and local treatment, while the hematoma was managed by drainage. Also, in our study two intraoperative complications occurred, that involved bleeding after hepatic biopsy with the LapVision system. They were managed conservatively, with drainage and good post-operative outcomes. Specific to the laparolift system, increased post-operative pain of the anterior abdominal wall was observed, caused by the mechanical lift.

Especially in six cases treated this way, the postoperative pain was very intense and high doses of painkillers were required. In two of these patients, pain was reported at the trocar site 3 weeks after surgery. Patients with acute abdomen, traumatic or not, where diagnosis is uncertain, in the setting of 13 , 14 :. In these patients, diagnostic gasless laparoscopy that identifies hemoperitoneum should be followed by laparotomy.

Gasless laparoscopy is a useful method for the differential diagnosis of acute abdomen causes in cases of extreme graveness and urgency. Use of this technique, allows clarification of the diagnosis and also acquisition of the necessary information to determine the appropriate therapeutic approach. In this way unnecessary laparotomies can be avoided. Another advantage is that this method uses only local or regional anesthesia, which makes it possible to be performed easily, even on the emergency department setting.

In addition, the simplicity of the method makes it economically feasible. National Center for Biotechnology Information , U.

Journal List Hippokratia v. Author information Copyright and License information Disclaimer. Nalcescu str. Copyright , Hippokratio General Hospital of Thessaloniki. Abstract Background: The diagnosis of acute abdomen in the emergency setting, still remains a challenging problem. Methods: This study included 49 patients that were managed with gasless laparoscopy for the diagnosis of acute abdomen, from to Conclusion: The gasless technique for laparoscopy is an extremely useful mean of diagnosis in emergency conditions, or for patients with contraindications to undergo laparoscopy by pneumoperitoneum.

Keywords: Laparoscopy, gasless laparoscopy, emergency, contraindications. Introduction The differential diagnosis of acute abdomen remains a complex clinical issue because, on one hand the patient involved could be already compromised and the time available for diagnosis limited, and on the other hand due to frequent lack of diagnostic means [computed tomography CT , magnetic resonance imaging MRI , ultrasonography US ].

Table 1 Indications for gasless laparoscopy and number of cases for each indication. Open in a separate window. Figure 1. Number of cases diagnosed by gasless laparoscopy as distributed based on their diagnosis. Table 2 Treatment based on diagnosis made by gasless diagnostic laparoscopy. In parentheses is the number of cases. Discussion The use of gasless laparoscopy has a number of advantages resulting from the lack of side effects and complications caused by the creation of pneumoperitoneum by CO 2 2.

Basically, the target patients for this type of investigation are: 1. Critical patients with major anesthetic risk, 2. Conclusions Gasless laparoscopy is a useful method for the differential diagnosis of acute abdomen causes in cases of extreme graveness and urgency. Conflict of interest The authors declare no conflict of interest. References 1. Gasless laparoscopy in abdominal surgery. Surg Endosc. Abdominal wall lift. Low-pressure pneumoperitoneum laparoscopic surgery. Hypercarbia during carbon dioxide insufflation for therapeutic laparoscopy: a note of caution.

Surg Laparosc Endosc. Gasless laparoscopic technique of wide excizion for gastric gastrointestinal stromal tumor versus open method.

World J Surg Oncol. The gasless laparoscopic cholecystectomy. Endosc Surg Allied Technol. Randomized comparison of conventional and gasless laparoscopic cholecystectomy: operative technique, postoperative course, and recovery.

ANDRZEJ BRYCHT PDF

Gasless Laparoscopy in Abdominal Surgery

Gasless Laparoscopic Surgery is a laparoscopic procedure that does not require the use of gas carbon dioxide during the procedure. However, after realizing that there are many unfavorable effects using the conventional laparoscopic method, doctors found a way to get rid of the gas and still end up with a successful operation. With Gasless Laparoscopic Surgery procedure, gas loss will be prevented because there is no gas used. The removal of specimen and suction can also be performed with ease. The insufflation of the abdominal cavity with gas carbon dioxide poses a lot of health hazards to the patient especially in patient with previous cardiopulmonary diseases. We know for a fact that increased carbon dioxide content will cause acidosis to the vital organs of the body. In worse cases, accumulation of carbonic acid can lead to kidney failure or even heart attack.

LENGUAJE ELFICO PDF

The role of gasless laparoscopy in differential diagnosis of acute abdomen

Metrics details. The purpose of this study was to compare the clinical outcomes and cost effectiveness of the gasless laparoscopic appendectomy GLA and conventional laparoscopic appendectomy LA. The two groups were comparable in age, gender, body mass index, symptom duration, ASA score, and white blood cell count. The mean surgical duration was Postoperative complications did not significantly differ between the two groups.

Related Articles