Abdominal Wall Lifting Devices as Alternatives to Pneumoperitoneum

Conventional laparoscopy requires pneumoperitoneum to elevate the abdominal wall for exposure. A continuous insufflation of a noncombustible gas in a sealed environment is essential. Undesirable physiological side effects have been observed with CO2 pneumoperitoneum. Furthermore, it has been necessary to retrain surgeons to use specialized instruments in order to operate on video images. Japanese and American investigators have recently used mechanical devices without pneumoperitoneum to elevate the abdominal wall for laparoscopic surgery. With their gasless technique, conventional instruments can be used, direct visualization of abdominal viscera is possible, and digital examination of abdominal contents can be performed without the fear o losing exposure. Since these procedures are being performed in a isobaric abdominal cavity, the risk of body fluid contamination to operating team is diminished when compared to open or traditional laparoscopic surgery. With this technique, transition from open to laparoscopic surgery is minimal; it should be added to the training of future surgeons.