Y Izumi1, T Kawano, T Iwai. 1. Department of Surgery, Tokyo Medical and Dental University, 4-5 Yushima 1, Bunkyo-ku, Tokyo 113-8519, Japan. y.izumi-k@komagome-hospital.bunkyo.tokyo.jp
Abstract
BACKGROUND: Gasless laparoscopy has the advantage of avoiding the risk inherent in pneumoperitoneum, but has not gained widespread popularity because of limited exposure of the operative field. Improved retraction devices are therefore needed. METHODS: A loop-shaped metallic retractor was designed for planar lifting of the anterior abdominal wall. Four types of retractor (5/6-, 3/4-, and 1/2-circle with rod at 90 degrees, and 1/2-circle with rod at 97 degrees ) were studied in 15 pigs. The device was then used for 47 patients. RESULTS: The 1/2-circle was the most smoothly inserted retractor and was significantly safer than the 5/6-circle (p < 0.05, Fisher's exact probability test). The 1/2-circle with rod at 97 degrees was utilized for clinical cases. This retractor can be readied within 1 min and was used successfully for all operations. CONCLUSIONS: This new retractor for gasless laparoscopic surgery provides good exposure and has the potential to enhance the performance of advanced laparoscopic surgery.
BACKGROUND: Gasless laparoscopy has the advantage of avoiding the risk inherent in pneumoperitoneum, but has not gained widespread popularity because of limited exposure of the operative field. Improved retraction devices are therefore needed. METHODS: A loop-shaped metallic retractor was designed for planar lifting of the anterior abdominal wall. Four types of retractor (5/6-, 3/4-, and 1/2-circle with rod at 90 degrees, and 1/2-circle with rod at 97 degrees ) were studied in 15 pigs. The device was then used for 47 patients. RESULTS: The 1/2-circle was the most smoothly inserted retractor and was significantly safer than the 5/6-circle (p < 0.05, Fisher's exact probability test). The 1/2-circle with rod at 97 degrees was utilized for clinical cases. This retractor can be readied within 1 min and was used successfully for all operations. CONCLUSIONS: This new retractor for gasless laparoscopic surgery provides good exposure and has the potential to enhance the performance of advanced laparoscopic surgery.