The new concept of gasless laparoscopy

To find out more about the new concept of gasless laparoscopy, also known as Lift-Laparoscopy, and its advantages, visit following websites:
www.Lift-Laparoscopy.com
or
www.MySurgeryPlace.net
or
www.EndoGyn.com

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.

More informations on www.Lift-Laparoscopy.com, www.MySurgeryPlace.net or www.EndoGyn.com

Why gasless Lift-Laparoscopy

Gasless Lift - Laparoscopy: New technique of laparoscopy without carbon dioxide gas Today, the surgical procedure known as keyhole surgery or minimally invasive surgery permits operations to be performed which formerly would have necessitated the use of the scalpel. Keeping the surgical wound as small as possible was for a long time the aim of physicians and surgeons. Therefore, surgical techniques were continually refined in order to gain access, with the minimum of adverse effects, to the site of disease. In gynecology, endoscopic investigations of the abdominal sex organs, such as the womb, fallopian tubes and ovaries, have a long tradition. Operations with the endoscope were also a routine procedure here. In the 70s laparoscopy was performed mainly for diagnosis or for tubal ligation. Thanks to the pioneer Professor Kurt Semm, from Kiel, more and more indications were established in Germany and worldwide. Today, laparoscopic procedures to treat benign manifestations in the ovaries and fallopian tubes (extrauterine pregnancy, ovarian cysts) as well as in the womb (myomas) are standard procedures carried out as a routine measure in endoscopic centers. The advantages of endoscopic operations for malignant cases cannot yet be definitively elucidated, which is why such operations are being conducted on an experimental basis in very few hospitals. Advantages of endoscopy Large surgical wounds are avoided on using endoscopy. Therefore, there is markedly less wound pain after surgery. The patient recovers and becomes mobile more quickly, hence the hospital stay is considerably shortened and indeed procedures can even be carried out in many cases on an outpatient basis. The cosmetic result is considerably better since only small scars remain. Wound healing disorders are seen less often after endoscopic operations than after open abdominal surgery, and there are fewer problems due to adhesions and scars. Risks and disadvantages of endoscopic operations But like all operations, endoscopic procedures also pose certain risks such as, for example, hemorrhage, organ injury or infection. Moreover, it can come to light in the course an endoscopic procedure that conventional surgery is warranted. Endoscopic procedures necessitate insufflation of the abdominal cavity with carbon dioxide in order to obtain a sufficient view of the surgical field and grant the surgeon enough space to work. This causes considerable build-up of pressure in the abdominal cavity and reduces the body temperature due to the cold gas, which in turn causes pain that in some cases can persist for several days, radiating to the shoulder and neck regions; these manifestations can prolong and complicate the recovery period. Moreover, the gas is held responsible for further side effects whose implications have not yet been adequately clarified. For example, there are increasingly more reports in the literature about incidences relating to carbon dioxide, which is converted in the body to carbonic acid. Long operations with carbon dioxide may lead, above all in older and less healthy patients, to a decrease in the pumping action of the heart or to overloading the organism with carbonic acid, and this in turn can cause acidosis of all organ systems. Insufflated gas can in very rare cases lead to gas accumulation in the vascular systems of the lungs (gas embolism), heart (decrease in coronary blood supply) and of the kidneys (poorer perfusion) or to the accumulation of carbon dioxide in the subcutaneous tissue of the skin (emphysema). While such side effects of carbon dioxide are extremely rare, they can prove fatal (kidney failure, heart attack, pulmonary embolism). Typical complications of an endoscopic procedure can occur while inserting the Verres needle - for gas insufflation - or the secondary trocars. This "insufflation needle" is pierced "blindly", i.e. without visual control, into the abdominal cavity. After the abdominal cavity has been filled with gas, the first trocar for the optic is inserted (also without visual control). Both can in rare cases cause injury to vessels or organs (for example the bladder, intestines, stomach and others), and this in turn can trigger emergency situations (e.g. bleeding) warranting immediate action. An undetected bowel injury following coagulation often results some time later in acute ileus and massive infection. Endoscopic operations are clearly more difficult and are therefore performed only by a few centers. By working with overly long, specially modified instruments, the surgeon loses tactile perceptions. The instruments are unfamiliar; they have the most diverse gripping systems and small graspers. All this detracts from precision during surgery. Only very few surgeons develop the ability to operate in the abdominal cavity with only indirect visual contact, i.e. looking at the monitor. Therefore, the learning curve associated with endoscopic surgical techniques is very long. The complication rate for endoscopic procedures is also higher than in open surgery, especially in the case of surgeons who are not yet optimally trained. This is also one of the reasons why, following the initial euphoria, stagnation can be noted in the spread of endoscopy. In order to avoid gas loss via the instruments, special trocars with valves were developed. The instruments themselves consist of multiple tubular and shaft systems which mimic the rotary and angled movements of the hand. To avoid gas loss while changing the instruments (for example between scissors and graspers), multi-functional instruments were developed. Industry has to make massive investments to manufacture these instruments, which is why the costs incurred for such instruments are much higher than in the case of conventional instruments. Endoscopic instruments are more laborious when it comes to maintenance and processing. Due to the myriad tubular systems, special washer-disinfectors must be purchased to clean these instruments and eliminate contaminants based on body secretions and blood which could cause infection. For the past 75 years (since the introduction of laparoscopy with carbon dioxide) industry has been trying in close cooperation with endoscopic surgeons to overcome the problems emanating from endoscopic procedures using gas. In the meantime, a very important market segment has therefore developed which, by continually developing newer instruments and equipment, makes endoscopic procedures using gas safer but also more expensive. The costs are spiraling due to, among other things, the use of special thread and suture materials, widespread use of disposables, such as titanium clip systems, suturing devices and angled instruments; all this calls into question the benefits of endoscopic procedures. Professor Axel Perneczky, neurosurgeon from Mainz, made the following statement regarding endoscopic surgery: "Keyhole surgery can be likened to a situation where we try to sew on a button on the bed linen in the bedroom with a tweezers through the keyhole of the front door; moreover, the rooms are full of furniture, around which we have to maneuver the tweezers..." Quotation by Dr. Daniel Kruschinski on the development and introduction of gasless laparoscopy: "Keyhole surgery can also be likened to a situation where we use a ladder to try to come in through a closed window of a bedroom on the first floor, although the front door is wide open..."
More to read at:
www.Lift-Laparoscopy.com
and
www.EndoGyn.com

Rural laparoscopy

MyLaparoscopyPlace
Here you can read only few facts about Lift - Laparoscopy. To learn more about Lift - laparoscopy, please go to the special website:
www.EndoGyn.com
www.MySurgeryPlace.net
Laparoscopy with gas (CO2 = carbon dioxide) has many disadvantages for patients and surgeons. Risks and disadvantages of the endoscopic procedure with Gas for the patientHigh pressure in the abdomen as well as a a decrese of body temperature)Subsequently pains, that can radiate as far as into the shoulder and neck-region partially for daysExtension of the recuperation-phaseOverload of the organism with carbonic acidAcidity of all organ systemsRare, but typical complications of an endoscopic operation can be: Injury of organs or vessels upon the Verress needle with which the gas is insufflated to the abdominal cavity or through the additional trocars, that can cause also dangerous emergency situations (for example bleedings or air embolism)Air embolism in the vascular system through injury of big vessels during the operation with following death admittedly is rare, but, to hardly exclude, since the needle, that is inserted into the abdomen, without view, is therefore inserted "blindly" and therefore this complications can not be avoided completely. You can read about other complications here > Why gasless. To make you understand what laparoscopy is like for the surgeon, please watch this: Would you eat your chicken like this ?With the long and unusual instruments with two joints, the surgeon is loosing his tactile sense, he simply looses his "hand". A surgeon without tactile sense is like a surgeon without hands... The surgery becomes less precise, difficult, dangerous and takes more time than a laparotomy. The operations with the long instruments are difficult to learn. Therefore worldwide only 10 % of the surgeons are performing laparoscopic surgery. Means 90 % are performing open surgery (laparotomies)! EndoGyn is not using such instruments, only instruments from open conventional laparotomy which allow tactile sense, are utilised for gasless Lift-Laparoscopy > (please see the difference here) The goal for EndoGyn is to eliminate such kind of instruments and to allow all surgeons to learn laparoscopic techniques to bring all the advantages of laparoscopy to all the patients throughout the world. Here are some slides with the advantages of Lift - Laparoscopy.Here you can read only few facts about Lift - Laparoscopy. To learn more about Lift - laparoscopy, please go to the special website:
www.EndoGyn.com
www.MySurgeryPlace.net