An abdominal wall-lift method of laparoscopic cholecystectomy without peritoneal insufflation.

Laparoscopic cholecystectomy is unusually performed with peritoneal insufflation of carbon dioxide gas, which limits the free use of conventional surgical techniques and is accompanied by operative risks resulting from trocar insertion, hypercapnia, and increased intraabdominal pressure. We have improved the laparoscopic cholecystectomy procedure by using an abdominal wall-lift technique that does not utilize peritoneal insufflation. The operative field is almost the same as in the pneumoperitoneum method with the exception of morbidly obese patients. Because airtightness between manipulating instruments and the abdominal wall is not required, we are able to use conventional surgical instruments and techniques in addition to those specifically designed for laparoscopic surgery. The abdominal wall-lift method enables us to perform laparoscopic surgery with greater ease than the pneumoperitoneum method. It can also be extended to other kinds of abdominal surgery in addition to cholecystectomy.