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. 2020 Jan-Mar;24(1):e2019.00061.
doi: 10.4293/JSLS.2019.00061.

Gasless Total Laparoscopic Hysterectomy with New Abdominal-Wall Retraction System

Mi Kyoung Kim  1 , Jong Ha Hwang, Jang-Heub Kim  2 , Soo Rim Kim  2 , Sae Bom Lee  2 , Bo Wook Kim  2
Affiliations

Gasless Total Laparoscopic Hysterectomy with New Abdominal-Wall Retraction System

Mi Kyoung Kim et al. JSLS. 2020 Jan-Mar.

Abstract

Background and objectives: Gasless laparoscopy is an alternative method to reduce the number of carbon dioxide (CO2)-insufflated, pneumoperitoneum-related problems including shoulder pain, postoperative nausea/vomiting, and decreased cardiopulmonary function. In this study, we investigated the feasibility of gasless total laparoscopic hysterectomy (TLH) with a newly developed abdominal-wall retraction system.

Methods: Abdominal-wall retraction for gasless laparoscopy was performed using the newly developed J-shape retractor and the Thompson surgical retractor. Surgical outcomes between gasless TLH and conventional CO2-based TLH were compared for each of 40 patients for the period from January 2017 to October 2019.

Results: Between gasless TLH and conventional CO2-based TLH, no significant differences were observed for age, body mass index, parity, or surgical indications. The mean retraction setup time from skin incision was 7.4 min (range: 4-12 min) with gasless TLH. The mean total operation times were 87.9 min (range: 65-170) with gasless TLH and 90 min (range: 45-180) with conventional TLH, which showed no significant difference. Estimated blood loss and uterus weight also showed no significant intergroup difference. No major complications related to the ureter, bladder, or bowel were encountered.

Conclusion: Our new abdominal-wall retraction system for gasless TLH allowed for easy setup and a proper operation field in the performance of laparoscopic hysterectomy.

Keywords: abdominal-wall retraction; gasless laparoscopy; laparoscopic hysterectomy.

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Conflict of interest statement

Conflict of interests: The authors declare there is no conflict of interest.

Figures

Figure 1.
Figure 1.
J-shaped retractor. A. stainless-steel J-shaped retractor. B, Plastic J-shaped retractor.
Figure 2.
Figure 2.
Abdominal-wall retraction for gasless TLH. A, Upper view using stainless-steel retractor. B, Lateral view using plastic retractor.
Figure 3.
Figure 3.
Representative laparoscopic view after setup for abdominal-wall retraction. A, View of anterior uterus. B, View of posterior uterus.
See this image and copyright information in PMC

References

    1. Makinen MT, Yli-Hankala A. The effect of laparoscopic cholecystectomy on respiratory compliance as determined by continuous spirometry. J Clin Anesth. 1996;8:119–122. - PubMed
    1. Pelosi P, Foti G, Cereda M, Vicardi P, Gattinoni L. Effects of carbon dioxide insufflation for laparoscopic cholecystectomy on the respiratory system. Anaesthesia. 1996;51:744–749. - PubMed
    1. Dorsay DA, Greene FL, Baysinger CL. Hemodynamic changes during laparoscopic cholecystectomy monitored with transesophageal echocardiography. Surg Endosc. 9:128–133, 1995; discussion 133–124. - PubMed
    1. McLaughlin JG, Scheeres DE, Dean RJ, Bonnell BW. The adverse hemodynamic effects of laparoscopic cholecystectomy. Surg Endosc. 1995;9:121–124. - PubMed
    1. Westerband A, Van De Water J, Amzallag M, Lebowitz PW, Nwasokwa O. Cardiovascular changes during laparoscopic cholecystectomy. Surg Gynecol Obstet. 1992;175:535–538. - PubMed

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