Instruments For Laparoscopic Surgery Research Articles

Costs and benefits of laparoscopic surgery--a review of the literature.

The purpose of this paper is to look at the cost-effectiveness of laparoscopic surgery in relation to conventional open surgery. It focuses both on the results and the methods, and aims to identify the need for further studies as well as the appropriate methods of economic evaluation. We searched the literature and identified studies in which "cost" or "cost-effectiveness" was mentioned in relation to open and laparoscopic surgery. Laparoscopic and open surgery were compared for gallbladder disease, inguinal hernia and gastro-oesophageal reflux disease (GORD). Finally, we reviewed studies that focused on cost comparisons of disposable compared with reusable instruments in laparoscopic surgery. We found that the evidence on whether laparoscopic surgery results in lower costs for the health care system than open operations is not conclusive. There are, however, indications that it results in savings in indirect costs from reduced periods of sick leave. There is also an indication that reusable instruments resulted in lower costs for each operation than disposable instruments. We conclude that a prospective, randomised study is the preferred study design in the early stage of the development of a new technique, when it is not fully obvious what the indications for the new technique are. This should be considered when doing economic evaluations of new indications for laparoscopic surgery, for example appendicectomy and non-inguinal hernia repair.

Systems and instruments for laparoscopic surgery without pneumoperitoneum.

The insufflation of carbon dioxide into the peritoneal cavity is a routine technique of abdominal exposure in laparoscopic surgery. Because of adverse physiological effects and technical disadvantages of the pneumoperitoneum, alternative methods of abdominal wall lifting have been explored recently. Two groups of retraction systems exist: intraabdominal lifting and subcutaneous lifting of the abdominal wall. Some systems require additional pneumoperitoneum, because the extent of intraabdominal exposure is not sufficient. Other systems are working completely without gas insufflation. Two systems combine abdominal wall lifting with pressure on the internal organs. Every method allows the use of standard laparoscopic instruments, which originally were designed for a regular pneumoperitoneum. The use of a low-pressure pneumoperitoneum in combination with mechanical augmentation of the peritoneal cavity reduces physiological disadvantages of laparoscopy. But technical advantages, such as combination of laparoscopic and open techniques, can be realized only without gas insufflation. Conventional instruments have been designed to fit the ergonomical needs of isopneumic laparoscopy and to be employed with simple valveless cannulae.