Laparoscopic surgery has been widely performed in gynecology, and performing laparoscopic surgery under pneumoperitoneum-free conditions is an important innovation and improvement of pneumoperitoneum surgery, which can eliminate the adverse effects of pneumoperitoneum on patients. After the exploration and practice of pneumoperitoneum laparoscopy in recent years, it has developed into an important branch of modern laparoscopy. The purpose of minimally invasive surgery is to complete the operation with as little damage as possible to the patient, including less trauma, less bleeding and rapid postoperative recovery. Compared with cesarean surgery, laparoscopic surgery has the advantage of minimal trauma and provides operating space for intra-abdominal surgery with the help of artificial pneumoperitoneum, but it often affects the pneumoperitoneum status due to the application of suction devices and the non-sealing of the trocar system or gas leakage during surgical incision of the vagina, which does not take advantage in terms of operating time, and there are also problems of surgical instruments and operating costs. Suspension laparoscopic technique is to provide an intra-abdominal surgical operating space without continuous gas maintenance by mechanical suspension of the abdominal wall for intra-abdominal surgery. Ma Qimin, Department of Obstetrics and Gynecology, Anyang Maternal and Child Health Hospital The operation is more convenient because there is no need to worry about air leakage during the operation without manual pneumoperitoneum. In addition to avoiding the complications of blind puncture during pneumoperitoneum establishment, C02
pneumoperitoneum and the complications arising from its formation of intra-abdominal pressure, there are also the following advantages: 1. the potential dangers of blind intra-abdominal puncture by the pneumoperitoneum method are avoided. 2, can use the instruments of traditional dissection, following the traditional suture and knotting techniques, so that the operation is easy and simple. 3.Surgical instruments can freely enter and exit the minimally invasive incision and quickly perform intra-abdominal suction to ensure a good surgical view without worrying about air leakage. 4, can be used without or less disposable instruments, abandoned pneumoperitoneum machine, so the input cost is reduced. 5, so that patients who cannot tolerate pneumoperitoneum can undergo minimally invasive surgery, such as pregnant women, severe cardiopulmonary abnormalities and elderly patients. 6, pneumoperitoneum method of laparoscopic surgery requires personnel training, especially to be more skilled in certain surgical operations; while suspension laparoscopic techniques only require simple instruction of surgical personnel with some experience in cesarean surgery, can carry out surgery. 7, for the safety of anesthesia, studies have shown that the pressure in the airway and the end-expiratory CO2 pressure rise significantly three minutes after the formation of the pneumoperitoneum, while both are almost unchanged during the operation of suspended laparoscopy, and the elevated pressure in the airway is the cause of pneumothorax, and the significantly elevated end-expiratory CO2 value can cause cardiac arrhythmia, etc. Suspended laparoscopic surgery can completely abandon general anesthetic intubation and utilize the most widely used epidural anesthesia, which reduces patient costs and also facilitates the popularity of the procedure. Second, surgical indications Only by fully understanding the limitations of pneumoperitoneum-free laparoscopic surgery (such as poor peri-abdominal exposure, increased surgical difficulty, the need for additional acquisition, and the inability to replace the pneumoperitoneum machine) can we objectively and scientifically evaluate its value as a complement to conventional (pneumoperitoneum) laparoscopic surgery, and then bring into play its unique superiority, such as eliminating or alleviating pneumoperitoneum complications and expanding surgical indications. Basic studies at home and abroad have shown that pneumoperitoneum laparoscopic surgery has significantly greater interference with patients’ cardiopulmonary function, intra-abdominal visceral blood perfusion and macrophage system than non-pneumoperitoneum laparoscopic surgery, and that pneumoperitoneum surgery can cause subcutaneous and mediastinal emphysema, hypercapnia, blood flow stasis, air embolism, and sometimes cardiopulmonary dysfunction by compression from the abdominal cavity to the thoracic cavity during prolonged surgery and excessive pneumoperitoneum pressure. For the elderly, especially patients with cardiopulmonary vascular disorders, it can lead to serious hazards, and also increase the risk of surgery and anesthesia, and even become a contraindication to surgery as a result. Some basic studies abroad have found that pneumoperitoneum helps the growth, implantation and dissemination of tumor cells. In the case of laparoscopic surgery without pneumoperitoneum, none of the above-mentioned risks exist, so it is obviously better than pneumoperitoneum surgery. Contraindications to surgery Weakness of the body cannot tolerate anesthesia; heavy bleeding tendency of malignant lesions of uterus and adnexa; serious infection of abdominal cavity; extreme morbid obesity or developed abdominal muscles; complex lesions that cannot achieve safe surgical purpose; heavy pelvic adhesions. Fourth, the anesthesia requirements because no pneumoperitoneum operation does not affect the patient’s breathing, so there is no need for tracheal intubation general anesthesia, epidural anesthesia can be, and do not need to add reinforcing drugs, intraoperative anesthesia management is simpler than general anesthesia, the patient does not have any intraoperative discomfort, postoperative also no two ribs and scapular tingling sensation. In contrast, pneumoperitoneum patients often report abdominal distention and pain during intraoperative inflation, gas suffocation and postoperative pain in both ribs and scapula. In conclusion, conventional gynecologic laparoscopic field exposure relies on CO2 pneumoperitoneum, and the operation must be performed in an airtight state under pneumoperitoneum, and the sutures are closed with the Endo
The GIA series of automatic suture cutters are expensive and not easily accessible. In contrast, our pneumoperitoneum-free surgery allows the attachment to be lifted outside the Trocar hole and the peeling and suturing operation is performed with ordinary surgical instruments, which is economical, time-saving and more delicate. Pneumoperitoneum is a procedure that achieves uniform pressure throughout the abdomen and therefore does not allow for more pressure or more space in a particular area to be operated on. Intraoperative air leaks or suction can also interfere with the operation and the surgical field of view, and require waiting time for inflation, not to mention the inability to perform the operation with conventional surgical instruments. Pneumoperitoneum laparoscopic surgery in surgical instruments such as vascular forceps can frequently enter and exit the abdominal cavity clamp tissue, electrocoagulation knife can directly enter the abdominal cavity electrocoagulation hemostasis, with ordinary suction can be suction while operating, does not affect the surgical field, even in obese patients the surgical field is also very clear, and can always discharge the smoke generated by electrocutting electrocoagulation tissue, still maintain the clarity of the surgical field, so it is especially suitable for hysterectomy and other surgeries that apply more electrocutting. It also reduces the dependence on special laparoscopic instruments, eliminates the need for pneumoperitoneum and carbon dioxide gas, and reduces the cost of surgery. Moreover, the abdominal wall is lifted at any time according to the surgical situation, and the advantages of laparoscopic surgery and open surgery are combined to achieve complementary advantages.