Laparoscopic Pneumodissection: A Unique Means of Tissue Dissection

Moon, Young Tae; Clayman, Ralph V

Abstract

The inability to bluntly dissect tissue inhibits the efficiency of laparoscopic surgery. To overcome this difficulty, we developed a 5mm laparoscopic pneumodissector(PD) capable of delivering brief bursts of high pressure CO2( 20-100 psi; approximately 1-7 atmosphere) for tissue dissection. After establishment of a pneumoperitoneum, 9 anesthetized female pigs underwent dissection of the right kidney and renal hilum using the PD(40-60 psi) as the primary mode of dissection. None of the study animals became hypercarbic during the use of the PD. Acute histological studies revealed marked hemorrhage in the spleen after direct contact at all pressures ; minimal ecchymoses occurred in the other tissues. No intimal damage was noted in the aorta, inferior vena cava, or renal vessels. Chronic histological studies 6 and 12 weeks after PD showed no discernible damage to liver. kidney, or perineal tissues. Also, acute and long term renal scans revealed no significant change in renal function. In this initial trial, PD at up to 60 psi( =4 atm) appeared to be a safe and effective method for rapidly expanding the perineal space and for dissecting both the perineal fat from the surface of the kidney and perihilar tissue from the renalvessels.