Pneumodissection-Aided Laparoscopic Cholecystectomy (PDLC) Using Innovative Pneumodissector in a Resource-Limited Setting

Abstract

The search for an efficient laparoscopic instrument for blunt tissue dissection during laparoscopic cholecystectomy is still on the cards. This article evaluated the efficacy of an innovative laparoscopic dissecting instrument, a pneumodissector. This instrument allows the surgeon to use short bursts of high-pressure room air to bluntly dissect fatty tissue to dissect the Calot’s triangle during laparoscopic cholecystectomy. Sixty-two patients undergoing laparoscopic cholecystectomy were divided into two arms. A 5-mm laparoscopic aspiration needle attached to a battery-operated air compressor, designed to act as pneumodissector, was used for pneumodissection-aided laparoscopic cholecystectomy in 31 patients (test arm) and 31 patients (control arm) underwent conventional laparoscopic cholecystectomy. Subjective assessment of the efficacy of the instrument was recorded. In addition, acid–base changes were measured by blood gas determination, and serum chemistries were obtained before, during, and after the procedure. The pneumodissector enhanced dissection of the Calot’s triangle with ease and shortened the operative time for laparoscopic cholecystectomy. Although statistically significant changes in acid–base values occurred with use of the pneumodissector, these changes were not clinically significant and were not different than what is normally seen during carbon dioxide pneumoperitoneum. Laparoscopic pneumodissection is a safe and efficacious technique for rapid blunt tissue dissection during laparoscopic cholecystectomy.