[A modular retraction system (VarioLift) for laparoscopy without pneumoperitoneum]

Because of adverse physiological effects and technical disadvantages of the pneumoperitoneum, alternative methods of abdominal wall lifting have been explored recently. Most of these systems are complicated in their system set-up and handling or the intraabdominal exposure is limited. The modular retraction system (VarioLift, AESCULAP Tuttlingen) consists of two different components, one for the abdominal wall lifting, and one for internal organ compression. Via a 2 cm mini-laparotomy two lifting parts of different size and shape are introduced into the abdominal cavity, assembled to each other and attached to an outside mechanical lifting arm which is suspended to the operating table. Using combinations of these parts, the system can be adjusted to different abdominal quadrants and the patient's individual anatomy. According to the needs of vision for internal organ compression a translucent plastic membrane can be placed for posterior organ retraction using the same access. In contrast to other systems the modular retraction system (VarioLift) allows an individual adjustment to the patient's anatomy and, if necessary, compression of internal organs. A planar suspension of the abdominal wall with a good lateral exposure and a dome-shaped suspension without tenting effects is provided. Time needed for mini-laparotomy and system set-up is only slightly longer than installation of a pneumoperitoneum.