Safe laparoscopic adhesiolysis with optical access trocar and ultrasonic dissection. A prospective study.
BACKGROUND
The objective of this clinical study was to examine the feasibility, safety, and adequacy of hemostasis of combined use of an optical trocar and ultrasonic dissection in laparoscopic adhesiolysis in patients with chronic abdominal pain.


METHODS
In 105 patients, identification of anatomic layers of the abdominal wall, establishment of pneumoperitoneum, completeness of adhesiolysis, hemostasis, and complications and pain relief were studied.


RESULTS
All abdominal wall layers could be determined during introduction as well as adherence of intraabdominal organs at the introduction site. Ultrasonic dissection enables an (almost) complete adhesiolysis in 103 (98%) patients and offered adequate hemostasis in 101 (96%) patients. Four perforations during laparoscopic adhesiolysis and no late (thermal) perforations were observed.


CONCLUSIONS
With an optical trocar a safe introduction site of the abdominal wall can be chosen. The ultrasonic technique offers a sound adhesiolysis with adequate hemostasis and fewer thermal perforations and adds to feasibility and safety of laparoscopic adhesiolysis.
Swank
D J
DJ
Department of Surgery, Groene Hart Hospital, Post Office Box 1098, 2800 BB Gouda, The Netherlands. djswank@XS4ALL.nl
Bonjer
H J
HJ
Jeekel
J
J
D015746:Abdominal Pain / Q000209:etiology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005336:Fiber Optic Technology / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013525:Surgical Instruments; D000267:Tissue Adhesions / Q000601:surgery*; D014465:Ultrasonics