ASSESSMENT OF WORKSPACE OF LAPAROSCOPIC CHOLECYSTECTOMY UNDER PNEUMOPERITONEUM AND COMBINATION OF PNEUMOPERITONEUM AND ABDOMINAL WALL LIFTING

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 64; no. 12; pp. 2975 - 2979
• Main Authors: URUSHIHARA, Takashi, SUMIMOTO, Kazuo, SHIMOKADO, Kiyoshi, KURANISHI, Fumito, KURODA, Yoshinori
• Format: Journal Article
• Language: English
• Published: Japan Surgical Association 2003
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.64.2975

It is essential to secure a visual field for safety under laparoscopic surgeries. Pneumoperitoneum enables surgeons to secure a sufficient workspace but high-pressure pneumoperitoneum may burden the cardiovascular system. Meanwhile, an insufficient visual field is the demerit of the abdominal wall lifting method. In order to overcome the demerits of these methods, we have created the combination method of 4mmHg low-pressure pneumoperitoneum and abdominal wall lifting to secure the visual field since 1993. In this study, intraperitoneal capacity was comparatively assessed based on the CO2 volume needed as the parameter for objectively assessing the workspace. The study enrolled 20 patients who underwent a laparoscopic cholecystectomy from January to December of 2001. There were seven men and 13 women, aged 35 to 80 with a mean of 59. The CO2 volume needed in the lifting procedure was 1.93±0.56L, and the pneumoperitoneal pressure to obtain the equivalent capacity was 7.98±1.39mmHg. On the other hand, the CO2 volumes needed under 4mmHg and 8mmHg pneumoperitoneum in the pneumoperitoneum alone versus in the combined procedure were 0.57±0.38L versus 2.62±0.74L and 1.98±0.59L versus 3.40±0.87L, respectively. It has been objectively demonstrated that a largerer intraperitoneal capacity is obtainable in the combination of pneumoperitoneum and lifting procedure than in the pneumoperitoneum or lifting procedure.