Did we ever stop to think that the main "gas" in gasless laparoscopy would be nitrogen?
Are you ready to play operation or are you ready to play........
For those of you who are just desparate for your next gasless laparoscopy......these folks can "hook" you up but they do have this caveat that may give a clue as to why Endogyn is constanly on the run!
They no it is not preferable, have know for years but continue to lure patients with their scientific mumbo jumbo.
“gasless” Laparoskopie
Translated from German
(The following text is co-ordinated with the president of the working group gynäkologische Endoskopie of the German society for Gynäkologie and birth assistance).
“Gas lots “Laparoskopie = room air Laparoskopie
This method finds in our region isolates application. We are addressed on that occasionally by female patients.
This concerns a simple variant of the Laparoskopie, which obtained attention for the first time in the 90's in Germany, however contrary to the standard Laparoskopie neither in the subject surgery nor in the subject Gynäkologie to become generally accepted could.
The name expresses that with this technology no medical CO2-Gas is introduced into the abdominal cavity around the abdominal cavity to unfold and place for the operational interference to create. Instead after opening of the abdominal cavity at the navel a handle is introduced and the abdominal wall is pulled up. It flows normal air with room temperature into the abdominal cavity. Air is definitv a gas. Thus the question arises whether the term is not unfortunately selected and/or misleading.*
In the work community Gynäkologi Endoskopie of the German society for Gynäkologie and birth assistance (AGE) is therefore alternatively the term “room air Laparoskopie” common (Professor Leo De Wilde, Oldenburg, president of the AGE.)
If air arrives over open veins with an operation into the Blutkreislauf, it causes clearly more easily a lethal Embolie than CO2, which is present always as product of the respiration in low concentration in the blood and can over the lung be abgeatmet. Also from the abdominal cavity air is only very slowly eliminated by the organism, which is less important however.Why thus at all “gas lots Laparoskopie” Around to understand one must develop little conception gift as a layman: With the standard Laparoskopie must be worked against to escaping the Aufdehnungsmediums with valves, so that the development of the abdominal cavity remains keeping upright. With the gasless technology one can save this expenditure. The raising of the abdominal wall guarantees the hook elevator by course at the navel. One can make and leave as many as desired and of any size holes open into the abdominal wall. Simple rubber cases replace expensive valve cases. Logical way can introduce one any instruments of the open belly surgery by these openings. A hospital can here evt. much money save, because this equipment is usually already present. With the standard Laparoskopie cannot be done that. Instruments must be exactly co-ordinated with the valve cases. One needs expensive special instruments and this depending upon OI spectrum evt. in large number. Because of the cost advantages the gasless Laparoskopie is naturally in poorer countries likes.For an operating surgeon trained in conventional surgery the conversion is not more simply, there it the handling of the delicate, different Laparoskopie instruments to learn must. To that extent the gasless Laparoskopie makes endoscopic untrained surgeon possible a simplified entrance into the Laparoskopie.Also from view of the Anästhesisten (Narkoseärzte) it gives to laproskopieren reasons “gasless”. The renouncement of CO2-Gas and the proportioned positive pressure in the abdominal cavity has advantages for certain risk female patients, essentially older humans. They can be endoscopic operated if necessary without body cut, although a standard Laparoskopie for them would not be possible.Problems:
One wants the clearly rougher conventional instruments and staunching of bleeding methods (Tupfer!) uses, needs one clearly larger wounds in the abdominal wall. The cosmetic result is then accordingly more unfavorable. The wound in the navel region must offer place not only for the hook elevator mechanism but also for the optics system. The necessary Wunddurchmesser amounts to about 20 mm. (Standard Laparoskopie to the comparison 5 - 11 mm.)
The effectiveness of the belly development is more unfavorable, than with the CO2-Laparoskopie, since the rise takes place only at one point. The result is a conical figure with the highest point at the navel. The operating surgeon needs most place however within the basin range. That succeeds with the even Aufdehnung with exactly proportioned CO2-Gasdruck more effectively. This is for us a operation-technically important point. The punctual pressure is not favorable on the fabric by the hook construction with long operations.
The room air cannot be warmed up. It prevails during the “gasless” OI in the abdominal cavity a lower temperature than with the CO2-Laparoskopie with body-warm gas (for this special devices are available.) the sinking of the fabric temperature has some important unfavorable metabolic effects (see below). Our result: The “gasless” room air Laparoskopie takes a central position between body cut and belly reflection for us. It has elements of both. Naturally a OI team equipped well for the standard Laproskopie could use its fine instruments also by gasless room air Laparoskopie. Then at least the wounds would be in the abdominal wall alike. Also those captivatingly precise Microchirurgie with miniaturized equipment under strong picture enlargement would be realizable. Disadvantages remained the worse development of the abdominal cavity and the missing possibility of the heating up of the belly by the warm gas. Waste of the Körpertemperatur changed among other things the Pharmakokinetik, increases the Sauerstoffverbrauch by cooling trembling, strengthens subjective measurement feeling, worsens the immune defense, increases the muscle strain (and with it the pain feeling). The blood clotting is affected unfavorably. (Literature: Gabriele Depenbusch: Be called tips against cool cases - Perioperative heat measures for patients still more effectively used. Intensively 2002; 10:165 - 174 George Thieme publishing house)We decided in the OPZ Hürth so far against the introduction of the room air Laparoskopie with the elevator technology. We would see the sense of the procedure only with completely special female patients, whom we cannot operate usually ambulatory, to e.g. older humans.
Wrong conceptions to the “gasless” room air Laparoskopie
With the gasless Laparoskopie used instruments are not in principle shorter and permit no more favorable or more relaxed attitude of the operating surgeon.
The production of the entrance to the abdominal cavity does not take place with the gasless Laparoskopie in a less dangerous kind. One does not have to dot the abdominal cavity for the execution of a CO2-Laparoskopie “blindly” with a Kanüle and not to also in-sting the Trokarhülsen “blindly”. One can use problem-free the “open” technology and manufacture the entrance under view. (Literature A. Maucher (1990), open Laparoskopie. gynäkol prax 14, 741-746, Hans's Marseille publishing house Munich) S. also for this the chapter “open Laparoskopie” on these homepage. The entrance technology furthest common with distance is however the “Blindpunktion)
The OI times are not shorter. Patients do not recover faster. The pain after the interference is not smaller. The medicine need is not smaller.
The results of the operations are better in no aspect, than with the CO2-Laparoskopie. The OI technology is not under any circumstances more precise.
„The gasless “Laparoskopie does not permit operational treatment, which one can realize not with the standard Laparoskopie. (Also the standard Laparoskopie permits surgical sewing, even with micro-surgical seam material under up to twenty-way picture enlargement).
The “gasless Laparoskopie” does not accompany with a lower total complication risk. The Embolie and Thromboserate are not lower.
Source:
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*Gases of room air
It contains roughly 78% nitrogen, 21% oxygen, 0.93% argon, 0.04% carbon dioxide, and trace amounts of other gases, in addition to water vapor.
This mixture of gases is commonly known as air.
http://en.wikipedia.org/wiki/Atmospheric
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