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A Journal on Internal Medicine

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Panminerva Medica 1999 December;41(4):371-7

language: English

The new tech­niques of gynaec­o­log­ic lapa­ros­co­py. Gasless, ­open Hasson, ­optic tro­car

Canes­trel­li M., Cannì M., Mori R., Blanc B., Trom­peo P.

From the Department of Obstetrics and Gynaecology, “E. Agnelli” Hospital of Pinerolo, Pinerolo (Torino), Italy
* Department of Obstetrics and Gynaecology, Conception Hospital of Marseille, University of Marseille, Marseille, France


Background. New tech­niques of lapa­ros­co­py: gas­less, ­open Hasson, ­optic tro­cars ­allow to ­avoid the ­risks of ves­sel and bow­el inju­ries. The objec­tive of ­this ­study was to eval­u­ate the capa­bil­ity of a retrac­tor ­system as an alter­na­tive to con­ven­tion­al tech­nique with­out pneu­mo­per­i­ton­eum and to ­assess if the ­system facil­i­tates the use of con­ven­tion­al sur­gi­cal instru­ments dur­ing gynaec­o­log­i­cal sur­gery.
Methods. Design: Prospective eval­u­a­tion. Setting: University- affil­i­at­ed ­county hos­pi­tal. Patients: Gasless lapa­ros­co­py sur­gery was per­formed on 49 ­patients ­between December 1995 and July 1996 ­with a retrac­tor ­system with­out pneu­mo­per­i­ton­eum con­sist­ing of an intrab­dom­i­nal retrac­tor ­using con­ven­tion­al sur­gi­cal and lapar­os­cop­ic instru­ments and to ­enable a simul­ta­ne­ous vag­i­nal ­approach.
Results. Gasless lapa­ros­co­py was suc­cess­ful in 44 (90%) of cas­es. A simul­ta­ne­ous vag­i­nal ­approach was ­used in one ­third of indi­ca­tions includ­ing vag­i­nal myo­mec­to­my and lapar­os­cop­ic assist­ed hys­ter­ec­to­my. Conversion to lap­a­rot­o­my was ­required in 5% of cas­es. Mean pro­ce­dure dura­tion was 90 min­utes and ­mean hos­pi­tal­isa­tion ­time was 5.7 ­days.
Conclusions. The intro­duc­tion of new tech­niques of lapa­ros­co­py: gas­less, ­open Hasson, ­optic tro­cars has broad­ened the appli­ca­tion of oper­a­tive lapa­ros­co­py. Gasless tech­nique in ­lieu of con­ven­tion­al lapa­ros­co­py can be per­formed reli­ably and safe­ly for ­most gynaec­o­log­i­cal indi­ca­tions. The ­most out­stand­ing ben­e­fit of ­this meth­od is ­that it can be com­bined ­with a vag­i­nal ­approach ­which is not pos­sible ­using a pneu­mo­per­i­ton­eum due to gas leak­age. The ­place of gas­less lapa­ros­co­py ­will ­depend on con­tin­u­ing devel­op­ment by instru­ment man­u­fac­tur­ers, in ­order to ­achieve an instru­ment pro­vid­ing ­vision as ­good as ­that ­seen ­with the pneu­mo­per­i­ton­eum.

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