Page 24 - Textbook of Practical Laparoscopic Surgery by Dr. R. K. Mishra
P. 24

CHAPTER 6: Abdominal Access Techniques  23

























                 Fig. 59: Laparofan attached with laparolift after introduction inside   Fig. 60: Abdolift (another variety of abdominal lifting device).
                                  abdominal cavity.






















                 A                                                 B
                                               Figs. 61A and B: Abdolift lifting the abdominal cavity.


                out and locked into a V by tabs on the plastic handle, which   BOX 1: Problems due to pneumoperitoneum.
                is fixed to the end of the adjustable arm. The maximum     • Hypothermia
                lifting force of 13.6 kg is equivalent to a pneumoperitoneum     • Cardiac arrhythmia
                pressure of 15 mm Hg. The laparoscope is inserted through     • Cardiovascular collapse
                the same incision, cephalad to the Laparofan.          • Pulmonary insufficiency
                   The physiologic changes associated with CO          • Gas embolism
                                                                       • Venous thrombosis
                                                                 2
                pneumoperitoneum are well tolerated in healthy patients     • Cerebral edema/ischemia
                but may result in life-threatening cardiac arrhythmia,     • Ocular hypertension
                myocardial infarction, cardiac failure, or pulmonary     • Extraperitoneal insufflation (subcutaneous emphysema,
                                                                      pneumomediastinum)
                insufficiency in compromised patients who cannot
                compensate for these alterations in hemodynamic
                (Box 1). A gasless laparoscopic approach could provide   continuous  suction  and  conventional  laparotomy
                an added margin of safety for these patients. Patients  instruments (Figs. 62 and 63).
                undergoing laparoscopic surgery for malignancy or
                laparoscopically assisted vaginal hysterectomy may also  Disadvantages of Gasless Laparoscopic Surgery
                benefit from gasless laparoscopy. Another potential   ■ ■Marked guttering effect of lateral abdominal wall
                advantage of gasless laparoscopy is the ability to use   results after lifting anterior abdominal wall.
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