Abstract
Background: Disadvantages related to CO2 pneumoperitoneum have led to development of the abdominal wall retractor (AWR), a device designed to facilitate laparoscopic surgery without conventional pneumoperitoneum (15 mmHg CO2). We investigated the effects of the AWR on hemodynamics and gas exchange in humans. We also investigated whether the use of an AWR imposed extra technical difficulties for the surgeon. A pilot study revealed that cholecystectomy without low-pressure pneumoperitoneum was technically impossible.
Methods: A prospective randomized controlled trial: Twenty patients undergoing laparoscopic cholecystectomy were randomly allocated into group 1: AWR with low-pressure pneumoperitoneum (5 mmHg), or group 2: conventional pneumoperitoneum (15 mmHg).
Results: Surgery using the AWR lasted longer, 72 ± 16 min (mean ± SD) vs 50 ± 18 min compared with standard laparoscopic cholecystectomy. There were no differences between the groups with respect to hemodynamic parameters, although a small reduction of the cardiac output was observed using conventional pneumoperitoneum (from 3.9 ± 0.7 to 3.2 ± 1.1 l/min) and an increase during AWR (from 4.2 ± 0.9 to 5.2 ± 1.5 l/min). Peak inspiratory pressures were significantly higher during conventional pneumoperitoneum compared to AWR. A slight decrease in pH accompanied by an increase in CO2 developed during pneumoperitoneum and during the use of the AWR. In both groups arterial PO2 decreased.
Conclusions: The results indicate that the view was impaired during use of the AWR and therefore its use was difficult and time-consuming. Possible advantages of this devices' effects on hemodynamics and ventilatory parameters could not be confirmed in this study.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Author information
Authors and Affiliations
Additional information
Received: 28 May 1996/Accepted: 14 October 1996
Rights and permissions
About this article
Cite this article
Meijer, D., Rademaker, B., Schlooz, S. et al. Laparoscopic cholecystectomy using abdominal wall retraction. Surg Endosc 11, 645–649 (1997). https://doi.org/10.1007/s004649900412
Published:
Issue Date:
DOI: https://doi.org/10.1007/s004649900412