title: Modified technique of gasless laparoscopic cholecystectomy in a developing country: a 5-year experience.
abstract: BACKGROUND
  Concerns and disadvantages associated with pneumoperitoneum have led surgeons to search for alternative techniques of exposure in laparoscopic surgery. We devised a modified technique of gasless laparoscopic cholecystectomy based on the concept of mechanical retraction of the abdominal wall.
  
  
  METHODS
  337 males and 663 females, mean age 52 (7-87) years and mean weight 68 (28-126) kg, with gallstone disease and subjected to this technique were evaluated retrospectively (1992-1997). Towel clips were applied at 3 points on the abdominal wall and it was lifted without creating a pneumoperitoneum. A single surgical team specialized and experienced in biliary surgery performed all the surgeries.
  
  
  RESULTS
  Of 1,000, 46 patients weighing more than 85 kg required a combination of mechanical abdominal wall retraction and minimal pressure pneumoperitoneum (5 mm Hg). The conversion rate was 6% but none were related to limitations of the technique. Technique-related morbidity was minimal. No common bile duct or visceral injury was recorded and mortality was 0%.
  
  
  CONCLUSIONS
  Gasless laparoscopic cholecystectomy is a feasible, safe and effective alternative to the pneumoperitoneum technique. It probably costs less and is therefore more useful in developing countries. However, it has limitation in overweight patients who are infrequently encountered in our population.
authors.affiliation: Department of Surgery, Shrikhande Clinic, Mumbai, India.
authors.forename: Anand G
authors.initials: AG
authors.lastname: Nande
authors.forename: Shailesh V
authors.initials: SV
authors.lastname: Shrikhande
authors.forename: Vipulroy
authors.initials: V
authors.lastname: Rathod
authors.forename: Kishor
authors.initials: K
authors.lastname: Adyanthaya
authors.forename: Vinayak N
authors.initials: VN
authors.lastname: Shrikhande
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D002769:Cholelithiasis / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013525:Surgical Instruments; D016896:Treatment Outcome