Gasless Laparoscopy During Pregnancy Advocated.

ORLANDO, FLA. -- Gasless laparoscopy avoids many of the risks associated with laparotomy or laparoscopy using dioxide pneumatic distension in pregnant patients who require surgery, Dr. Marco A. Pelosi Jr. and Dr. Marco A. Pelosi III said in a joint presentation at a meeting of the One Kilo Club.

The father and son team, who practice in Bayonne, NJ., noted that the safety of peritoneal [CO.sub.2] distension during laparoscopic surgery has not been unequivocally demonstrated, even though a growing body of literature has not established that it is teratogenic or otherwise detrimental to the mother or fetus.

"Potential deleterious fetal effects of [CO.sub.2] pneumoperitoneum, including its cooling effect, may be decreased by keeping the intraabdominal pressure below 15 mm Hg and avoiding prolonged operating time," the physicians wrote in a script that accompanied a videotape of several surgeries they performed on pregnant patients.

Still, using mechanical lifting arms can provide gasless abdominal wall elevation and avoid any potential risks of [CO.sub.2], including diaphragmatic irritation, increased maternal intraabdominal pressure, and, often, general anesthesia, the surgeons said at the meeting held in conjunction with the 37th International College of Surgeons' North American Federation Congress.

Serious cardiopulmonary risks of [CO.sub.2] insufflation, including arrhythmia, myocardial infarction, and pulmonary insufficiency, have been outlined in the medical literature.

Mechanical peritoneal distension using the Laparolift device, manufactured by Origin Medsystems in Menlo Park, Calif., has been described for a variety of surgical procedures. The device has an adjustable, telescopic arm attached to an electrical vertical lifting mechanism mounted to the operating table. It is attached to a spreading retraction device, the Lapaofan, made by the same company which is splayed into a "V" shape within the incision.

Studies comparing the device to [CO.sub.2] insufflation have found, in general, that it reduces cardiopulmonary risks but can impair visualization during certain procedures.