Mechanical augmentation of the peritoneal cavity in laparoscopic surgery — a new instrument set

Abstract

The pneumoperitoneum, generally used for laparoscopic procedures, is simple and safe. Disadvantages arise from the side effects of pressurized carbon dioxide. Thus insufficient abdominal wall lifting due to gas leaks, distended bowels or fatty internal organ stipulates the need of additional instruments. Cardiopulmonary risk is a contraindication and the reaction to local anaesthesia unpredictable. Spreadable instruments or the ACE (abdominal cavity expander) can be introduced to either push organs aside or suspend the abdominal wall. Additional incisions, instruments and their handling complicate the procedure. Yet the effect is poor as in open surgery, when only traction on the wall is applied. The new instrument combines traction of the abdominal wall and pressure on the internal organs. Two sleeves are introduced near the operational field under endoscopic control. An internal connector is attached under light compression of the abdominal wall. At the tips of two metal rods, that are conducted in the sleeves, a flat 12 by 15cm wide pressure-body is coupled. Being placed on the internal organs under view, the metal rods are pushed forward, slightly fixed by rubber friction. Additionally the instrument set allows one to lift the wall with a suspension at the operation table. The instrument set was tested in six pigs and later used with nine cholecystectomies and four hernia repairs in humans. After a learning curve the installation took 6 min. The connections of instrument parts were stable, the pressure body could be moved over a large area. The translucent material allowed permanent control of the circulation. The obtained vision was sufficient, the intra-abdominal pressure could mostly be lowered. No assistance was needed and even with a laparotomy the instrument set was left in place and used for wall suspension. The improvement of intra-abdominal vision under low pressure pneumoperitoneum allows minimal invasive therapy under local anaesthesia and possibly in patients with cardiopulmonary risks.

Key Words:

• low pressure pneumoperitoneum
• peritoneal mechanical augmentation
• visual access