title: Videolaparoscopic cholecystectomy. Analysis of the clinical and functional aspects of mechanical lifting of the abdominal wall.
abstract: BACKGROUND
  Mechanical lifting of the abdominal wall, a method based on traction and consequent elevation of the abdominal wall, is an alternative procedure to create enough intra-abdominal space necessary for videolaparoscopic surgery, dispensing the need for intraperitoneal gas insufflation.
  
  
  OBJECTIVE
  This study aims to evaluate the technical feasibility of this procedure to carry out a videolaparoscopic cholecystectomy, while analyzing the clinical and functional aspects of this technique.
  
  
  METHODS
  In the Digestive Tract Surgery Discipline of the Medical School at the University of São Paulo, São Paulo, SP, Brazil, was created the equipment to perform videolaparoscopic surgery using this method. The equipment has two sections: an external part which consisted of a frame attached to the operating table, inside which there is a sliding steel cable, moved by a ratched which is located at the lower end of one of the frame rods; the internal rod, the support, has an "L" shape, and its horizontal branch is made up of three turning rods and which is connected to the steel cable after insertion into the abdominal cavity. Ten patients underwent videolaparoscopic cholecystectomy using this equipment. The time taken to install the equipment, the operating area characteristics, the interference from the lifting equipment on surgical movements and on the intra-operative cholangiography, the measurements made of the force used during traction and extension of the abdominal wall elevation, and the medication required for postoperative analgesia were all evaluated.
  
  
  RESULTS
  There were no intra-operative complications, and in none of the cases was it found necessary to convert to open surgery. We considered the insertion a safe and uncomplicated procedure, and the traction system efficient. Apart from the elevation of the abdominal wall, the distribution of the viscera inside the abdominal cavity is fundamental for the operating area. Depending on the position of the epigastric trocar, the lifting equipment can interfere with the surgical instruments mobility. It may be necessary to reposition the support to perform the intra-operative cholangiography. The tensional force applied to the peritoneal surface by the lifting rods is small, and no additional postoperative pain was observed using this procedure.
  
  
  CONCLUSIONS
  These results show that using the equipment described in this study, mechanical lifting of the abdominal wall is a feasible alternative for undertaking videolaparoscopic cholecystectomy.
authors.affiliation: Videolaparoscopic Surgery Unit of the Digestive Tract Surgery Discipline at São Paulo University Medical School, São Paulo, SP, Brazil. santomarco@uol.com.br
authors.forename: M A
authors.initials: MA
authors.lastname: Santo
authors.forename: C E
authors.initials: CE
authors.lastname: Domene
authors.forename: A
authors.initials: A
authors.lastname: Nasi
authors.forename: P
authors.initials: P
authors.lastname: Onari
authors.forename: P
authors.initials: P
authors.lastname: Volpe
authors.forename: H W
authors.initials: HW
authors.lastname: Pinotti
mesh_terms: D000009:Abdominal Muscles / Q000601:surgery*; D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial; D020535:Video-Assisted Surgery / Q000295:instrumentation / Q000379:methods*