Access to the Abdominal and Thoracic Cavity

Safe establishment of a pneumoperitoneum is of paramount importance in minimally invasive surgery. Gas insufflation of the abdominal cavity is necessary to create sufficient working space by suppressing the viscera and elevating the abdominal wall. Variously shaped retractors inserted through a small incision and connected to a lifting device have been employed to elevate the anterior abdominal wall and avoid use of gas. However, this technique, gasless laparoscopy, does provide inferior exposure compared to a pneumoperitoneum, and, therefore, has been largely abandoned.