Abstract

SummaryThe pneumoperitoneum, generally used for all laparoscopic procedures, can lead to specific disadvantages and result in complications, and represents a restriction of the surgeon's freedom of movement. Alternative methods to create sufficient abdominal exposure without pneumoperitoneum have been proposed all over the world. After a description of the most popular solutions, we describe our first experiences with an electromechanical retractor system for laparoscopic surgery. A fan formed wall retractor, which is attached to an electric lift-arm, is introduced into the abdominal cavity. After raising the abdominal wall, the laparoscopic procedure can be started without the technical and physiopathological problems which may occur using a pneumoperitoneum. In this way we performed gasless laparoscopic surgery on 121 patients: cholecystectomy (n = 78), abdominal exploration for NSAP (n = 6) or tumour staging (n = 12), fenestration of liver cysts (n = 7) and appendectomy (n = 18). In this gasless laparo...

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