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Low‐pressure Pneumoperitoneum for Laparoscopic Surgery Using a Disposable, Flexible Abdominal Wall Retractor
Author(s) -
INOUE Haruhiro,
MURAOKA Yukihiko,
TAKESHITA Kimiya,
GOSEKI Narihide,
ENDO Mitsuo
Publication year - 1993
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/j.1443-1661.1993.tb00632.x
Subject(s) - medicine , pneumoperitoneum , retractor , abdominal wall , surgery , cauterization , laparoscopic surgery , adhesion , cosmesis , laparoscopy , anesthesia , chemistry , organic chemistry
Since April 1991, we have studied 160 patients who had had a successful laparoscopic cholecystectomy. Nine patients who presented with chronic cholecystitis with severe local adhesion and who were also considered to require a longer operative time were selected as suitable candidates for this procedure. They were successfully treated under a zero‐ to four‐mmHg low‐pressured pneumoperitoneum procedure combined with total abdominal wall lifting using a disposable, flexible vinyl tube retractor. This method enabled exactly the same clear laparoscopic vision as is possible in the routinely‐used high‐pressure pneumoperitoneum even in the marginal portions of the abdominal cavity. Moreover, it facilitated early reinsufflation after the cauterization‐produced smoke was exhausted, which minimized the operative time and reduced the surgeon's anxiety concerning the maintenance of a sufficiently airtight condition. We believe that this low‐pressure pneumopeqitoneum procedure also benefits the poor‐risk patient who has restricted cardiopulmonary function, especially during advanced laparoscopic surgery which requires a longer operative and anesthetic time.