title: Combination of subcutaneous abdominal wall retraction and optical trocar to minimize pneumoperitoneum-related effects and needle and trocar injuries in laparoscopic surgery.
abstract: BACKGROUND
  Both pneumoperitoneum and blind needle and trocar insertion may cause complications: because of the well-known physiological effects, CO2 insufflation is not indicated in patients with impairment of cardiorespiratory function and high-risk patients; injuries to underlying viscera and vessels by needles and trocars have been reported even when the open technique is used.
  
  
  METHODS
  A technique which combines abdominal wall suspension by a new subcutaneous lifter (LaparoTenser) and optical trocar (OptiView) insertion has been evaluated in a random series of 22 patients undergoing various laparoscopic procedures. The optic trocar was inserted without previous insufflation, but low-pressure (1-5 mmHg) pneumoperitoneum was associated during the course of the procedure in 16 cases.
  
  
  RESULTS
  The exposure of the operating field was good or sufficient in 21 cases (95%), while the placement of the optical trocar was always safe. One complication related to the insertion of the subcutaneous needles of the wall lifter occurred (suprafascial hematoma).
  
  
  CONCLUSIONS
  The subcutaneous retractor allows the use of conventional cannulae and the combination of abdominal wall suspension with or without low-pressure pneumoperitoneum, thus enhancing the quality of exposure with no effect on the hemodynamic and respiratory functions.
authors.affiliation: 4th Department of Surgery, Policlinico Umberto I, University La Sapienza, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Angelini
authors.forename: M M
authors.initials: MM
authors.lastname: Lirici
authors.forename: V
authors.initials: V
authors.lastname: Papaspyropoulos
authors.forename: F L
authors.initials: FL
authors.lastname: Sossi
mesh_terms: D000009:Abdominal Muscles / Q000293:injuries*; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D016602:Needlestick Injuries / Q000150:complications / Q000517:prevention & control*; D055095:Optics and Photonics; D010529:Peritoneal Cavity / Q000293:injuries; D011027:Pneumoperitoneum / Q000209:etiology / Q000517:prevention & control*; D013525:Surgical Instruments / Q000009:adverse effects*