Gasless laparoscopy provides minimal-access surgery in resource-limited countries

Reuters Health - 14/09/2020 - Gasless laparoscopy could allow more patients to undergo minimal access surgery in low- and middle-income countries (LMICs), according to a new clinical trial.

The logistics of providing medical-grade gases in remote areas make it difficult to adopt minimal access surgery in low-resource settings, meaning that many patients have to undergo open surgery where safer, less invasive laparoscopic surgery might otherwise be possible.

Gasless laparoscopy mechanically elevates the abdominal wall and allows visualization through a single incision, thereby enabling diagnostic and therapeutic procedures, Dr. Anurag Mishra of Maulana Azad Medical College, in New Delhi, and colleagues write in the Journal of the American College of Surgeons.

The team compared gasless laparoscopy (GAL) versus conventional laparoscopy for general surgical procedures in their noninferiority randomized study of 100 patients. They excluded patients with an American Society of Anesthesiologists (ASA) score of 3 or higher, a BMI above 28, multiple intraabdominal conditions, or a history of previous abdominal surgeries.

Mean operative time from incision to closure, the primary outcome, was nonsignificantly shorter in the GAL group (52.9 minutes) than in the conventional laparoscopy group (55 minutes).

Setup times were also similar for GAL and conventional laparoscopy.

Three cases of cholecystectomy were converted from GAL to conventional laparoscopy, and three conventional laparoscopy cases were converted to open procedures due to technical difficulties.

There were no intraoperative complications or mortality.

Although pain was not severe at any time in either group, visual analog scale pain scores were significantly higher in the GAL group than in the conventional laparoscopy group at 24 hours and 48 hours after the procedure. Analgesic requirements were similar in the two groups.

The overall incidences of surgical site infections and delayed wound healing were similar in the two groups.

The average surgeon satisfaction score with GAL was 6.4/10 and was higher for the second 25 cases (7.24) than for the first 25 cases (5.56).

"Gasless laparoscopy is a noninferior alternative to conventional laparoscopy in terms of operative time and pain," the authors conclude. "We advocate for its wider use in low resource settings to extend the benefits of minimal access surgery over open surgery to selective patients in the population. This technique if implemented, can revolutionize rural surgery and achieve the goal of 'safe and affordable surgery for all.'"

The gasless laparoscopy technique used in this study is available online at https://www.youtube.com/watch?v=eezVUqcD7yM.

Dr. Mishra did not respond to a request for comments.

By Reuters Staff

SOURCE: https://bit.ly/3lQ8qJt Journal of the American College of Surgeons, online August 18, 2020.



Posted on 14 September 202030 September 2020