Gasless laparoscopic cholecystectomy: comparison of postoperative recovery with conventional technique

We have compared, in a randomized study in 26 patients, immediate and late postoperative recovery after elective laparoscopic cholecystectomy using the gasless, mechanical abdominal wall lift method with conventional carbon dioxide pneumoperitoneum. After the gasless method, tracheal extubation was performed significantly earlier than after the conventional method (P < 0.01). End-tidal carbon dioxide concentrations were significantly higher after pneumoperitoneum for 30 min after operation (P < 0.01). In the conventional group, deviation in Maddox-Wing recordings from preoperative values remained at a significantly higher level during the 3-h recovery room period (P < 0.01). There was a positive correlation between the total amount of carbon dioxide used and duration of drowsiness (r = 0.61, P < 0.001) and the Maddox-Wing deviation (r = 0.62, P < 0.001). Postoperative nausea and vomiting, and right shoulder pain occurred less often after the gasless method (P < 0.05). Late recovery criteria (ability to drink, void and walk) in patients in the gasless group were fulfilled approximately 7 h earlier than in those in the pneumoperitoneum group (P < 0.01). Gasless laparoscopic cholecystectomy resulted in more uneventful and faster immediate and late postoperative recovery than conventional carbon dioxide pneumoperitoneum.