Jan D, Petra G, Lubomír M, Igor G, Miloslav M, Ale F

Language: Spanish
References: 15
Page: 17-20
PDF size: 69.09 Kb.

ABSTRACT

Objective: To assess the advantages and disadvantages of gasless laparoscopic cholecystectomy and to compare this method with laparoscopic cholecystectomy using pneumoperitoneum.
Design: Prospective, randomized study.
Statistical analysis: We used Student’s t and chi-square tests. Statistical significance was set at p ‹ 0.05).
Material and methods: The study was performed in 50 patients with indication of elective cholecystectomy from October to December 2005. Patients were randomly assigned to two groups. The first group was operated using pneumoperitoneum with CO₂ and the second was operated without gas –VarioLift system. We assessed surgical time, number of conversions, intra- and post-operative complications, as well as length of post-operative hospital stay.
Results: We analyzed gender, age, BMI (Body Mass Index), ASA (American Society of Anesthesiology) classification, and number of previous intra-abdominal surgeries. In the group of patients operated with pneumoperitoneum the average surgical time was of 62 minutes, two intra-operative complications (minimal bleeding) were encountered, one conversion had to be made, there were no post-operative complications and the average hospital stay was of 2.6 days. In the groups subjected to gasless cholecystectomy the average surgical time was of 71 minutes, there were two intra-operative complications (minimal bleeding), three conversions had to be made, there was one complication during the post-operative period, and the average hospital stay was of 2.4 days. No significant differences were found in the analyzed variables between the two groups.
Conclusion: Gasless laparoscopy widens the possibilities of minimally invasive surgery and benefits those patients that cannot be subjected to laparoscopic surgery with pneumoperitoneum.

REFERENCES

1. Mayol J, García-Aguilar J, Ortiz- Oshiro E, De Diego Carmona JA, Fernandez-Represa JA. Risks of the minimal access approach for laparoscopic surgery: multivariate analysis of morbidity related to umbilical trocar insertion. World J Surg 1997; 21: 529-33.

2. Safran DB, Orlando R 3rd. Physiologic effects of pneumoperitoneum. Am J Surg 1994; 167: 281-6.

3. Cunningham AJ, Brull SJ. Laparoscopic cholecystectomy: anesthetic implications. Anesth Analg 1993; 76: 1120-33.

4. Gazayerli MM. The Gazayerli endoscopic retractor model 1. Surg Laparosc Endosc 1991; 1: 98-100.

5. Cuschieri A. Neue Technologien in der laparoskopischen. Chirurgie Chirurg 2001; 72: 252-60.

6. Mayol J, Vincent-Hamelin E, Sarmiento JM, Ortiz-Oshiro EQ, Díaz-Gonzáles J, Tamayo FJ, et al. Pulmonary embolism following laparoscopic cholecystectomy: report of two cases and review of the literature. Surg Endosc 1994; 8: 214-7.

7. Dwerryhouse SJ, Melsom DS, Burton PA, Thompson MH. Acute intestinal ischaemia after laparoscopic cholecystectomy. Br J Surg 1995; 82: 1413.

8. Giraudo G, Brachet Contul R, Caccetta M, Morino M. Gasless laparoscopy could avoid alteration in hepatic function. Surg Endosc 2001; 15: 741-6.

9. Nguyen NT, Perez RV, Fleming N, Rivers R, Wolfe BM. Effect of prolonged pneumoperitoneum on intraoperative urine output during laparoscopic gastric bypass. J Am Coll Surg 2002; 195: 476-83.

10. Glantzounis GK, Tselepis AD, Tambaki AP, Trikalinos TA, Manataki AD, Galaris DA, et al. Laparoscopic surgery-induced changes in oxidative stress markers in human plasma. Surg Endosc 2001; 15: 1315-9

11. The Japanese Association of Abdominal Wall Lifting for Laparoscopic Surgery, Comparison between CO2 insufflation and abdominal wall lift in laparoscopic cholecystectomy. A prospective multiinstitutional study in Japan. Surg Endosc 1999; 13: 705-9.

12. Vezakis A, Davides D, Gibson JS, Moore MR, Shah H, Larvin M, et al. Randomized comparison between low-pressure laparoscopic cholecystectomy and gasless laparoscopic cholecystectomy. Surg Endosc 1999; 13: 890-3.

13. Berberoglu M, Taner S, Dilek ON, Demir A, Saris S. Gasless vs gaseous laparoscopy in the treatment of hepatic hydatid disease. Surg Endosc 1999; 13: 1195-8.

14. Jiang JK, Chen WS, Yang SH, Lin TC, Lin JK. Gasless laparoscopy-assisted colorectal surgery. Surg Endosc 2001; 15: 1093-7.

15. Bruns CJ, Wolfgarten B, Kasper M, Zenner D, Walter M, Manich B. Gasless videoendoscopic implantation of aortobifemoral vascular prostheses via transperitoneal versus extraperitoneal approach in an animal model. Surg Endosc 1998; 12: 137-41.