Modified technique of gasless laparoscopic cholecystectomy in a developing country: a 5-year experience

Concerns and disadvantages associated with pneumoperitoneum have led surgeons to search for alternative techniques of exposure in laparoscopic surgery. We devised a modified technique of gasless laparoscopic cholecystectomy based on the concept of mechanical retraction of the abdominal wall.

337 males and 663 females, mean age 52 (7-87) years and mean weight 68 (28-126) kg, with gallstone disease and subjected to this technique were evaluated retrospectively (1992-1997). Towel clips were applied at 3 points on the abdominal wall and it was lifted without creating a pneumoperitoneum. A single surgical team specialized and experienced in biliary surgery performed all the surgeries.

Of 1,000, 46 patients weighing more than 85 kg required a combination of mechanical abdominal wall retraction and minimal pressure pneumoperitoneum (5 mm Hg). The conversion rate was 6% but none were related to limitations of the technique. Technique-related morbidity was minimal. No common bile duct or visceral injury was recorded and mortality was 0%.

Gasless laparoscopic cholecystectomy is a feasible, safe and effective alternative to the pneumoperitoneum technique. It probably costs less and is therefore more useful in developing countries. However, it has limitation in overweight patients who are infrequently encountered in our population.