The Improvement of Gynecological Gasless Laparoscopic Surgery Using a Subcutaneous Abdominal Wall Lifting Method

Background: To evaluate the usefulness of gasless laparoscopic surgery using a Subcutaneous Abdominal Wall Lifting method (SAWL) for gynecological tumors. Methods: 5309 patients underwent gasless surgery with SAWL in our hospital between April 1993 and December 2015. Patient background as well as the number of annual cases, operation time, estimated blood loss, number of ports, blood transfusion, and shift to laparotomy were examined. With regards to Laparoscopic Cystectomy (LC), Laparoscopic Myomectomy (LM) and Laparoscopic Tubectomy (LT), we divided their cases into two stages-the first stage (FS) that we performed surgery with double-operated ports (1993-2005), and the second stage (SS) after a single-operated port surgery introduction (2008-2015) for comparison. Results: LC was the most frequently performed (2068 patients), followed by LM (1738 patients) and LT (510 patients). A single-operated port laparoscopic surgery, which we called a Gasless Reduced Port Surgery (GRPS), was introduced in 2005, and by 2008 it had accounted for almost 90% of gasless laparoscopic surgeries overall except for total laparoscopic hysterectomy. The mean operation time was significantly shorter in SS than FS for LC and LT, and it was no significant difference between two stages for LM. The estimated blood loss significantly decreased in SS compared to FS for LM and LT, and no significant difference for LC. The conversion rate in SS was 0.07%. Conclusion: GRPS is an operative procedure that is superior to the rate of conversion to laparotomy and is aesthetically superior in addition to having advantages of the conventional gasless method.