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This interesting treatise begins with a well-done historical review of laparoscopy. The disadvantages of carbon dioxide pneumoperitoneum, some real and some hypothetical, are noted. The authors' analysis of gasless laparoscopy is informative and gives the reader a historical perspective of this evolving technique.
The midportion of the text is devoted to the application of the techniques to three areas of general surgery, the biliary tract, herniorrhaphy, and bowel resection. The retractor system used is described in detail and involves an intraabdominal device attached to a hydraulic lifting apparatus.
The majority of experience has been in cholecystectomy, with fewer operations done for hernia and colon resection. Of interest is the report of a hernia repair with epidural anesthesia.
In cholecystectomy and bowel resection the advantages of being able to use traditional instruments are stressed. This aspect of the technique is particularly attractive, since it may lower instrumentation costs and facilitate procedures
Carey LC. Gasless Laparoscopy With Conventional Instruments: The Next Phase in Minimally Invasive Surgery. JAMA. 1994;272(3):247. doi:10.1001/jama.1994.03520030091045