Gasless Laparoscopy
Another alternative is gasless laparoscopy. The peritoneal cavity
is expanded using abdominal wall lift obtained with a fan retractor. This technique
avoids the hemodynamic and respiratory repercussions of increased IAP and the consequences
of the use of CO2
.[250]
[251]
[252]
[253]
[254]
Renal and splanchnic perfusion is not altered.[126]
[255]
Postoperative pain, nausea, and vomiting
are
reduced after cholecystectomy,[250]
although not
after gynecologic laparoscopy.[256]
[257]
Port-site metastases after laparoscopic surgery for cancer are also reduced after
gasless laparoscopy.[258]
[259]
This technique therefore is appealing for patients with severe cardiac or pulmonary
disease. However, gasless laparoscopy compromises surgical exposure and increases
technical difficulty.[252]
[258]
[259]
Combining abdominal wall lifting with low
pressure CO2
pneumoperitoneum (5 mm Hg) may improve surgical conditions.
