Advantages of gasless Lift – laparoscopy

Advantages for the patient:

by dispensing with insufflation of carbon dioxide, there is considerably less pain after surgery. Essentially, the shoulder pains observed after endoscopic procedures are avoided or greatly reduced. The patient needs fewer painkillers compared to laparoscopy with gas. The recovery period is shorter, with the patient returning to normal activity faster than after laparoscopy with gas; for instance the recovery period after a hysterectomy is only approx two weeks. The operation is safer and more precise because one can dispense completely with the long and unfamiliar instruments. The risk of infection posed by inadequately cleaned endoscopic instruments and by different tubular and pumping systems is eliminated. The serious complications associated with "blind" insertion of the Verres needle or trocars into the abdominal cavity are avoided, because in gasless laparoscopy the abdominal cavity is accessed under visual control. Complications from clips, suturing systems or electrical coagulation, e.g. injuries to the ureter during an endoscopic hysterectomy, are avoided. The not yet foreseeable late complications caused by titanium clips remaining in the body, which must still be investigated, can be avoided. 

All aforementioned side effects, risks and complications caused by carbon dioxide are avoided, so that in addition to young and healthy patients, older or risk patients can also be operated on with the gasless method. This technique also makes it possible to perform endoscopic procedures under regional anesthesia, something that was not hitherto possible because of the massive pressure from the pneumoperitoneum in the abdominal cavity, which causes pain and organ compression (diaphragm, lung). Operations can also be conducted on pregnant women using gasless laparoscopy, as there is no pressure build-up, caused by gas, on the growing uterus (miscarriage, decreased perfusion of the placenta and of the baby). Gasless laparoscopy in pregnancy can be carried out as it avoids acidity of the blood of the fetus so that organ damage can be prevented and, moreover, the operation can be performed without general anesthesia. 

Domenico D'Ugo, anesthesiologist from Rome, stated in 1997 at the International Symposium on Gasless Laparoscopy in Gynecology: "The use of carbon dioxide is almost the only reason for exclusion of risk patients from laparoscopy, who in truth would be the only ones to benefit from the minimally invasive procedure …" 

Advantages for the surgeon:

the dangerous complications, which are typical of endoscopic surgery, resulting from "blind" insertion of the Verres needle for gas insufflation or of the first trocar are avoided. In addition to special instruments, the surgeon can also use traditional surgical instruments. Accordingly, sutures can be applied using the tried and tested needle and thread method instead of clip and suture apparatus or electrical coagulation, which are expensive or can cause complications and whose benefits have not yet been clarified. Tried and tested surgical techniques which have proved themselves over decades can also be used, thus enhancing precision and safety and shortening the operating time. Unlike when using the long endoscopic instruments, the surgeon preserves tactile manual perceptions and can thus feel what he is cutting, holding or compressing. With the magnification conferred by the endoscope, the operation unfolds more precisely and more safely. Also the learning curve associated with the gasless technique for the surgeon is markedly shorter, because he need only learn how to interact with the monitor since the surgical technique remains the same as that practiced in open abdominal surgery and is therefore easier. 

Advantages for the healthcare system:

minimally invasive operations using laparoscopy with carbon dioxide are about seven times more expensive than laparotomy. Minimally invasive operations with gasless laparoscopy are more cost effective as they dispense with systems that render laparoscopy with gas expensive. Instruments can be cleaned in the same way as hitherto, no special washer-disinfectors are required. Conventional instruments last considerably longer, they do not break as often as those instruments used for the gas method and need not be repaired or replaced so often. Neither is it necessary to continue using every novel instrument and technique that comes on the market so that the safety and maneuverability of gas laparoscopy can be improved. With the gasless method, no disposables are used, such as titanium clips and special threads which are enormously expensive. By combining the minimally invasive technique (short hospital stay and recovery period) with the cost effectiveness of the gasless method, this method of surgery is overall markedly more favorable than laparoscopy with gas. This technique is simple and easier to learn, so that more surgeons, who have so far not performed endoscopy surgery due to its inherent difficulties, can employ this technique and therefore more patients will benefit from the minimally invasive surgical method. Especially in the poorer countries of our world where, because of lack of the appropriate equipment and the high costs of devices and instruments, endoscopic surgical techniques were scarcely encountered or introduced, patients can be operated on with laparoscopy using the lifting technique.