title: Water-filled laparoendoscopic surgery (WAFLES): feasibility study in porcine model.
abstract: OBJECTIVE
  Recent surgical techniques have been advancing under endoscopic view and insufflation of carbon dioxide gas to expand the abdominal cavity. Isotonic fluid could be one candidate for expanding cavities to facilitate surgical maneuvering. We tested the feasibility and drawbacks of replacement of irrigating materials using a porcine model (water-filled laparoendoscopic surgery [WAFLES]).
  
  
  METHODS
  Laparoscopic cholecystectomy was performed in two porcine models using instillation of sorbitol solution as irrigant. Solution irrigation was performed through one of four ports, with drainage via another port. Conventional forceps equipped with a monopolar electrode for electrocautery, laparoscope, video processor, ultrasound, and transducer for measuring intraabdominal pressure were used.
  
  
  RESULTS
  Laparoscopic cholecystectomy was successfully undertaken with the following benefits: (1) clear observation of the dissecting plane throughout maneuvering; (2) control of oozing and spilled bile by irrigation and suction; and (3) ultrasonographic and laparoscopic images can be obtained simultaneously without any restriction to probe location. However, two disadvantages should be noted: (1) difficulties in managing floating organs and (2) interruption of vision by blood.
  
  
  CONCLUSIONS
  WAFLES provides some benefits for endoscopic surgery with proper devices, including apparatuses for irrigation and suction. Efficient irrigation and selection of proper irrigant and apparatuses are required to establish an acceptable procedure.
authors.affiliation: Division of Artificial System Engineering, Chiba University, Chiba City, Chiba, Japan. igarashi@faculty.chiba-u.jp
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Igarashi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Shimomura
authors.forename: Tadashi
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawahira
authors.forename: Harufumi
authors.initials: H
authors.lastname: Makino
authors.forename: Wen-Wei
authors.initials: WW
authors.lastname: Yu
authors.forename: Yukio
authors.initials: Y
authors.lastname: Naya
mesh_terms: D000818:Animals; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005240:Feasibility Studies; D007202:Indicators and Reagents; D023421:Models, Animal; D013012:Sorbitol; D013552:Swine; D007507:Therapeutic Irrigation; D014867:Water
chemical_list: D007202:Indicators and Reagents; D014867:Water; D013012:Sorbitol