MANY of Daniels patients have
returned home with reports from him stating they had NO adhesions in the
second look! Within a few weeks or months, they are left wondering
why and what is causing pain that seems to be from “adhesions,” but how
could it be if they were adhesion free when they left Germany! These
patients start the same process of diagnostic tests, pain medications,
fears that this pain is for life and NOT from adhesions, do not be to quick
to claim a success out of Endogyn as in doing this without giving yourself
time to REALLY know if in fact you did receive a “clean” peritoneum from
a surgery at Endogyn, what your doing is feeding information and hope to
a very desperate and suffering group of people who will do everything they
can to get there for their “miracle,” only to learn to late that YOUR story
wasn’t as good as you represented it to be! They turn to Daniel with questions,
only to be offered another surgery, at a discount, and if this is refused
him, watch out! (You will see why I say this!)
http://www.adhesionrelateddisorder.com/Dawn-Rose-Op-Reports.html
It is my desire, if not my duty to try to talk to you with some
candor about what is happening at Endogyn, Emma Klinic, Frankfurt, Germany
under the auspices of Daniel Kruschinski. This isn’t the first time I have
approached this subject, and the times prior to this can be found recorded
in black and white, within IHRT.
Back in 2003, & 2004, I was accused of unjustly “persecuting”
Daniel Kruschinki, and others whom favored his attention, however, the
line between investigating and persecuting is a very fine one...and my
dear people, by no means were my intentions meant to persecute anyone during
those times, nor are they meant to persecute anyone today with all of this
rhetoric about Endogyn. Today, as in the other episodes dealing with Endogyn,
I will deliver my points with facts, and tell the truth of these issues
by using peoples own words, and I do this to bring to you information that
I think will protect you from making decisions that are NOT in your best
interest!
I am of the opinion that all human beings have a built-in allergy
to unpleasant or disturbing information, but unless we recognize that if
we insulate ourselves from the realities of the world in which we live,
the world of ARD, we will be kicked around, and bullwhipped, and damned!
We easily become victim to “hearsay, rumor, gossip, unfounded information,
unconfirmed reports, and false promises! We can easily fall prey
to those who seek to benefit in both “financial” and “egotistical” ways
by using methods that distract, delude, amuse, sidetrack and isolate us
so that when they come in for the “kill,” we are non the wiser of the scam!
There are those who look at all of this “Endogyn banter” in
shock and repulsed by it, and there are those who work at perpetrating
it... and both may see a totally different picture of it all, but no matter
the sides taken in these issues, for some, it is too late to make a difference!
If what I say about this depravity in Endogyn in the material I write
is responsible, then I alone am responsible for the saying of it, but I've
searched my conscience and I can't, for the life of me, find any justification
for NOT bringing it to the attention of the public.
I also can accept that there are, on every story, two equal and
logical sides to an argument, and understanding the position those promoting
Endogyn have put me in, causes me to produce hard facts backed by credible
material in my attempts to protect more persons afflicted with “Adhesion
Related Disorder” from coming into harm by seeking a surgery at Endogyn
by means that they might otherwise think are credible!
The line between investigating and persecuting is
a very fine one...however, I will not walk by fear of another’s words against
me, I will not keep silent because the subject is “unpopular & uncomfortable”
for some, I will not speak words that only seek approval from others, and
never question or challenge, because I do not fear to write, to associate,
to question or to challenge, nor do I fear being “questioned” & “challenged,”
when it comes to defend the causes of persons afflicted with “Adhesion
Related Disorder.” To be “silent” only serves to give considerable
comfort to those who perpetrate crimes against other, thus when I see an
injustice, I will not remain silent!
I may have been instrumental in the beginning for promoting
Endogyn, however, when the reality of the situations there became evident
to me, I immediately made them public and did my best to expose the truth,
but even in that attempt to save others from the dishonesty and harm that
was going on at Endogyn, I cannot escape responsibility
for the results.
The material you are about to read is NOT
what I THINK it to be, but what I KNOW it to be!
The more the subject of, “The Hypoxic
Side Effects of Carbon Dioxide by Gasless Laparoscope’s,” is researched
by me, the more it appears that all of us were deceived by information
and claims made by Daniel Kruschinski, Karen Steward, & Helen Dynda,
among others, about the hypoxic side effects of carbon dioxide by
gasless laparoscopy! Other information presented by them,
is bogus as well, and I will stand by my words unless it can be shown otherwise!
Though this “exposure” of facts might
be to late for many who went to Endogyn because they believed the words
of these people, it is still better late, then not at all! For all who
are either, NOT “well” from the experience, or “worse”
for the experience, and in a number of cases, financially harmed by one
or more return trips to Endogyn because they “trusted another surgeon in
hopes of securing desperately need medical intervention for ARD,” I am
so sorry. “May God Bless you!”
For all who perpetrated this deception
against your own group of people, “May God Be Kind to You,” when
you face him, if you face him, in the mean time, I hope you
lose sleep knowing that you led many to additional injury at Endogyn because
of your selfishness and egotistical goals in life! I will state that I
do not think that Daniel created this situation he finds himself in today,
(all of this hype about him and his 100% miracle procedures,) I am of the
opinion that some of his patients simply felt that because someone they
knew got better from his surgery, they were wanting of that for everyone,
One big problem there though, was they wanted that so bad that when others
did not get well, they turned to unscrupulous means to harvest patients
to Daniel, who merely exploited it and rather successfully.
I will be showing you, through the
posts of persons making what appear to be “unsubstantiated” claims
about the “benefits” to patients having abdominal/pelvic surgery at Endogyn
with the “Abdolift.” The posts you are about to read, are only a
fraction of such posts making claims for "research" and "stats" regarding
the "benefits" of "gasless" surgery.)
Suggestion:
If you go into one of the URL’s to find
information related to "Gasless surgery"
use your PC keyboard as follows to make
your search easier:
* Simply click the keys "Ctrl " and "F"
* At the same time and a box will appear for you to type in the word "gasless."
* This maneuver will automatically highlight where every word, " gasless"
is mentioned
within the article.
* You can do this with ANY word on Any page you bring up in your computers!!
You are now ready to enter the
pages of “The Endogate Papers!”
(1) Credentials of Daniel Kruschinski, M.D.
The following post by Helen Dynda is a good
example of someone making claims that either have no validation associated
to the remarks in the post, nor do the URL links contain validation of
the claims made here, as the material in the URL’s, comes only from Daniel
himself, or his wife, about himself, no documentation anywhere to validate
any of these claims. I would ask Helen, or Daniel, where the statistics
are for the claim of 2500 cases, and I would also ask for documentation
and abstracts for the areas of “clinical & scientific” research, as
without that validation, there was no “clinical & scientific.” After
all, people, the whole point of research IS the validating material from
it! This type of email is so miss-leading to patients and simply
should never be posted by a patient assuming this “authority” in words,
and something like this is meant for one thing, to draw patients to this
surgeon, and in the worst way…by miss-leading and fraudulent means. If
it cannot be proven, it should never be said as in this, it is offering
to someone what does not really exist! A post such as this is a real threat
to desperate & vulnerable ARD patients as they have a certain trust
when other patients speak and when the words are empty, it is nothing more
then a set up! (More on Karl Storz Abdolift benefits to come, and the “benefits”
to patients are NOT what you have been led to believe by Daniel and Co.)
(1-A) Helen
Dynda.
More advanced
Gender: Female
Location: Hoffman, MN 56339 USA
Registered: Aug 2003
Status: Offline
Posts: 180
Credentials of Daniel Kruschinski,
M.D.
Posted Monday, February 27,
2006 @ 02:04 AM
Dr. Daniel Kruschinski is one of the founders
of the gasless laparoscopy in gynecology. Since 1990, Dr. Kruschinski has
performed scientific and clinical research in this pioneering field, also
known as Lift-Laparoscopy, with more than 2500 advanced operative cases.
He
developed and designed several abdominal wall-lifting systems, including
the recent AbdoLift, a Karl Storz product. Dr. Kruschinski is currently
involved in franchising endoscopic gynecologic surgery in Germany and other
countries.
http://www.endogynserver.com/cgibin/210/cutecast.pl?session=g3Z9EvgDUWOg9iHagXenLf8RD3&forum=2&thread=2253
(2) Laparoscopic
surgery does NOT reduce adhesions !!!
The “SCAR2” report that Daniel is referring
to has nothing to do with anything between “ gasless & CO@” surgical
procedures, it if the focus of “adhesion” formation in a laporoscopy! Daniels
words would suggest that either he doesn’t known how to read a scientific
report, or he is totally absorbed with his gales adhesiolysis, or else
he would realize that HE performs
a laporoscopic surgeryusing
HIS preferred technique which is gasless! And, really now, anyone who knows
nothing
about ARD, would still now that 1 in 3000 gasless laps is nothing short
of a “miracle!” However, Daniel & Co. DID claim they had miracles!
Please take a look at another report regarding this issue directly under
Daniel’s post here.
(2-A) Doc_Kru
Most advanced
Gender: Male
Location:
Registered: Jul 2003
Status: Offline
Posts: 253
Laparoscopic surgery does NOT reduce adhesions
!!!
Posted Wednesday, October 8, 2003 @ 12:38
PM
Quoting Daniel, “The
following article shows that laparoscopic surgery has the same amount of
readmissions for adhesion, regardless if the previous surgery was laparoscopic
or open...
A very interesting article and I
know from over 3000 gasless-laparoscopies I had only one admission because
of adhesions. I believe that a laparoscopy
with carbon dioxide with a duration of more than 30 minutes might have
plenty of side effects, that are proven in
experimental studies to be deleterious to the peritoneal cells. Due
to the fact that I'm the only one with such huge amount of gasless surgeries,
it would be interesting to have a study gasless contra carbon dioxide laparoscopy
regarding adhesion formation and I would like to find a gas laparoscopic
surgeon that would contribute to such a study--------------------“Daniel
Kruschinski, MD)
http://www.endogynserver.com/cgibin/210/cutecast.pl?session=g3Z9EvgDUWOg9iHagXenLf8RD3&action=&forum=2&thread=377&user=&query=&msgid=&page=&sort=&do=&key=&others=
Other aspects of: Laporoscopy vs Laporotomy
(2-B) Fertil
Steril. 1991 Oct;56(4):792.
Postoperative adhesion development after operative
laparoscopy: evaluation at early second-look procedures. Operative Laparoscopy
Study Group.
[No authors listed]
To assess the issue of the frequency and severity
of adhesion reformation and de novo adhesion formation after operative
laparoscopy, this multicenter collaborative report of early second-look
procedures after operative laparoscopy was initiated. Sixty-eight subjects
underwent operative laparoscopic procedures including adhesiolysis, followed
by a second operative procedure within 90 days. The total mean adhesion
score decreased from 11.4 +/- 0.7 at the initial operative procedure to
5.5 +/- 0.4 at the second-look procedure, a decrease of 52%. At the time
of the second-look procedure, 66 of 68 women (97.1%) had pelvic adhesions.
Adhesion reformation occurred in 66 of 68 women and at 230 of 351 sites
(66%) at which adhesions were lysed. Despite this high incidence of adhesion
reformation, de novo adhesion formation after operative laparoscopy occurred
in only 8 of 68 women (12%) and at 11 of 47 available sites in these 8
women. We conclude that adhesion reformation is a frequent occurrence after
operative laparoscopy; however de novo adhesion formation appears to occur
much less frequently.
More: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1826277&dopt=Abstract
PMID: 1826277 [PubMed - indexed for MEDLINE]
Successful Adhesiolysis Laporoscopies:
(2-C) Confluent
Surgical
Clinical Publications
Ferland,
R., et al, Evaluation of SprayGel TM Adhesion Barrier System as a Barrier
for the
Prevention
of Adhesion Formation After Gynecological Surgery
Mettler,
L., et al, A Prospective Clinical Trial of SprayGelTM as a Barrier to Adhesion
Formation: Interim Analysis
Preclinical Publications
Jacobs,
V.R., et al, A Pressure-Balanced Sprayer for Intraabdominal Application
of Soluble Biomaterials in Laparoscopy.
Jacobs,
V.R., et al, SprayGelTM as New Intraperitoneal Adhesion Prevention Method
for Use in Laparoscopy and Laparotomy.
Pricolo,
V.E., et al, Comparison of Peritoneal Adhesion Prevention in a Porcine
Model
More: http://www.spraygel.com/spraygel/posters.htm
(3) NOT one word about any “tissue damage in any
of them, except for Daniel’s
that is!
Lets take
a look at this post by Daniel one more time.
We agree that it is probably a “fact” that Daniel does (did) do a huge
amount of gasless surgeries, however, what I find “interesting” is that
Daniel thinks a “study” on gasless contra carbon dioxide laparoscopy and
adhesion formation.
Ah, I was led to believe that he had already
done a “study” like this as if he didn’t how could he tell us that there
WAS a difference, thus the reason people went to him for a gasless adhesiolysis!
The good news for Daniel is that there HAVE been studies just like he is
interested in, and you will find, “just a sampling” of such studies directly
under this post of Daniels!
(3-A) Doc_Kru
Most advanced
Gender: Male
Location:
Registered: Jul 2003
Status: Offline
Posts: 253
Laparoscopic surgery does NOT reduce adhesions
!!!
Posted Wednesday, October 8, 2003 @ 12:38
PM
http://www.endogynserver.com/cgibin/210/cutecast.pl?session=g3Z9EvgDUWOg9iHagXenLf8RD3&action=&forum=2&thread=377&user=&query=&msgid=&page=&sort=&do=&key=&others=
The following article shows that laparoscopic
surgery has the same amount of readmissions for adhesion, regardless if
the previous surgery was laparoscopic or open...
A very interesting article and I know from
over 3000 gasless-laparoscopies I had only one admission because of adhesions.
I believe that a laparoscopy with carbon dioxide with a duration of more
than 30 minutes might have plenty of side effects, that are proven in experimental
studies to be deleterious to the peritoneal cells.Due
to the fact that I'm the only one with such huge amount of gasless surgeries,
it would be interesting to have a study gasless contra carbon dioxide laparoscopy
regarding adhesion formation and I would like to find a gas laparoscopic
surgeon that would contribute to such a study--------------------Daniel
Kruschinski, MD)
(3-B) Laparoscopy Gasless vs.
CO2 Pneumoperitoneum
Volume 42, No. 5/May 1997
Pamela L. Johnson, Ph.D., M.D., and Karen S.
Sibert, M.D.
OBJECTIVE: To compare gasless laparoscopy
with conventional laparoscopy using CO2 pneumoperitoneum.
STUDY DESIGN: Women undergoing bilateral laparoscopic
tubal coagulation (LTC) were randomly assigned to one of two laparoscopy
procedures: (1) a gasless laparoscopy system consisting of an intraabdominal
fan retractor and electrically powered mechanical arm, and (2) standard
CO2 pneumoperitoneum laparoscopy. The two laparoscopic procedures were
compared on the basis of intraoperative visualization, operation duration,
procedural difficulty, ventilatory parameters, hemodynamic stability, and
postoperative pain and nausea. Full abstract......
(3-C) Interview: “ The differences
between what you are doing and what is performed during traditional laparoscopy
using carbon dioxide gas.”
Dr. Hugo Verhoeven:
“Good
afternoon, my name is Hugo Verhoeven, I am a member of the Editorial Board
of OBGYN.net.
I’m reporting from 9th Annual Congress of the International Society for
Gynecologic Endoscopy at the Gold Coast in Queensland. It is now my special
honor to interview Dr. Bernd Bojahr of the Department of Obstetrics and
Gynecology of the University of Greifswald in Germany. His specialty is
gasless endoscopy and the topic that we are going to discuss today is the
use of gasless laparoscopy in ...
Dr. Bernd
Bojahr: “Thank you. At our hospital we have
established the gasless technique since September of 1995.
Dr. Hugo
Verhoeven: “So the efficacy seems to
be the same whether you perform laparotomy or gasless laparoscopy.
Read more... http://www.obgyn.net/infertility/infertility.asp?page=/avtranscripts/Aus-endo-congress_bojahr
(4) Daniel states,
“hypoxic side effects of carbon dioxide in CO2.”
All I am going to say about these top three
posts is that I see ONE, and ONLY ONE, surgeon
making the claims that “CO2 causes peritoneal damage causing adhesion formation,”
and it is THIS
one! I found many abstracts on the “hypoxic side effects of carbon dioxide
in CO2 laporoscopic surgery, and the issues in all of them dealt with
concerns other then “hypoxic side effects of carbon dioxide in CO2.”
I also see that this same surgeon always
uses his wife’s “research” on this subject. Not “abstracts” mind you, but
simply written reports of, said, “research.” Until there are comparable
reports, with abstracts, that exactly parallel Shirli’s studies, we must
consider hers to be biased in favor of her husband. To accept ONE
persons “research” on anything would be like asking Daniel for a reference,
and he gives you his wife’s name!
Based on everything I have researched
on this subject, the only conclusion I can draw regarding Daniels findings
is that he saw a group of patients who are desperate, vulnerable &
ignorant in many areas of medicine when it comes to ARD. Once he
realized how easy it would be to “exploit” us after all the “accolades
and hype” from a few American women, he also saw lots of MONEY! Though
Daniel established the center for minimally invasive surgery and was in
charge of consulting hours for plastic surgery of the breast, he claimed
to be a “plastic” surgeon and started to offer “abdominal scar revisions,”
which is a totally different type of procedure then breast tissue! There
are a number of his prior patients who trusted Daniel’s words here, and
now pay a horrific price for that! Again, I can only deduce that Daniel
saw an opportunity to capitalize on ARD patients, and he did!
http://www.endogyn.de/index.php?seite=endogyn&sprache=en&a=EndoGyn&b=Physicians&c=DrKruschinski
Tonya’s story: http://myweb.cableone.net/DNORDQUIST/frmain.htm
Quoting Daniel from an email to me, Bev, dated Tuesday, April 08,
2003 10:32 AM
“I have been working a long time in the oncology departement
at Mainz university and I
even know how to form a new bladder from bowel, so I'm very experienced
in all retroperitoneal and bowel and urological surgery.” With all of this
skill, why would he target those afflicted with ARD? One would think he
could keep busy in these two areas of his professionalism, unless he realized
that he could make more money from International ARD verses what he makes
by performing surgeries on what he would get paid for with the German government.”
Like so many others in the field of surgery, once persons afflicted with
ARD started to shout it to the world, all of a sudden, EVERY surgeon became
an adhesion specialist! (And many without the “credentials” IHRT set to
back that claim!)
(4-A) Doc_Kru
Most advanced
Gender: Male
Location:
Registered: Jul 2003
Status: Offline
Posts: 253
Posted Wednesday, October 8, 2003
@ 12:40 PM
Comment on adhesion formation by using carbon
dioxide gas .....
http://www.endogynserver.com/cgibin/210/cutecast.pl?session=g3Z9EvgDUWOg9iHagXenLf8RD3&forum=2&thread=873
"I was asked to write about a comment to a post
about carbon dioxide, made on one of the message boards.
Sally (Grigg) was trying to explain the risks
of gasless laparoscopy by her own words, to make it clear to patients,
but the response was anything else than: " there is no risk of carbon dioxide
regarding adhesion formation...as a doctor, who was asked about it, said,
there is no risk..." I'm not speaking about MY PERSONAL PREFERENCE how
to perform surgery, as "I would say, I drink tea with milk, as it tastes
better, other drink without ", I'm speaking about the evident
data that is collected and published by experimental studies and clinical
reaserch! Not the "postoperative effects on
the body" are important, but the destructive
effect of carbon dioxide that causes injury / lesion to the peritoneum
and by this causes adhesion formation.
!!! First of all, please look at Shirli's biochemical
explanation here:
http://www.endogynserver.com/cgi-bin/210/cutecast.pl?session=NiLgCvS6sifDMo475pIa4jsuLF&forum=21&thread=898
Lack of oxygen in and around the cells is evidently
caused by using [B]CO2 gas as is usually being done in an endoscopic surgery
(!)… Already after 5 minutes of ischemia there is a significant production
of free radicals that have not enough oxygen
to react with.
Therefore free radicals will be initiating
adhesion formation, starting with cytolysis
of these cells (cells are broken) and peroxidation of lipids in cell membrane
that lead to an increase in the vascular permeability
that cause among other things (damage that produce adhesions) also an imbalance
in fibrin deposition and fibrin dissolution
(blood clotting and dissolution of the clots) which produce fibrinous
adhesions Using carbon dioxide gas we are inducing adhesion formation
by lowering the level of special molecules that are needed for the healing
process and so carbon dioxide is an (for the
surgeon) invisible instrument that causes injury (lesion) to the peritoneum
with the result of adhesion formation!
Regards --------------------Daniel Kruschinski,
MD)
(4-B) Doc_Kru
Most advanced
Gender: Male
Location:
Registered: Jul 2003
Status: Offline
Posts: 253
Posted Thursday, October 9, 2003 @ 02:24 AM
The hypoxic side effects of carbon dioxide by
gasless laparoscopy ...
http://www.endogynserver.com/cgi-bin/210/cutecast.pl?session=ICUsWfLyNECbm18kPm9cl0rIHF&forum=2&thread=377
Hi Karen,
it's always nice to hear Melissas's story... thank you.
But one thing has to be said: regardless to what kind of tools one
is using, in my opinion, THE SURGEON is the most important issue in an
adhesiolysis, in any surgery. So if you give him good tools, it doesn't
mean, he will be suddenly a magician, if he wasn't before.
With every new good tool we use, it makes us a little better.
Another topic is how to reduce adhesions by administration of different
medications, like antibiotics, mitomycin, vitamines and antioxydative systems
to reduce radicals.
Another important tool is to reduce smoke (produced by Laser and
extensive coagulation) as smoke is directly acting as a radical by decreasing
oxygen in the cells... and off course to stop the hypoxic side effects
of carbon dioxide by gasless laparoscopy ... or administration of Oxygen
(Koninckxs)
Regards ------------------Daniel Kruschinski, MD)
(4-C) gasless laparoscopy!!
From: Karen Steward (kann@charter.net)
Sun May 18 22
http://www.adhesions.org/forums/ADHESIONS.0305/0248.html
Subject: gasless laparoscopy!! Do you understand the effects on the
body by the carbon dioxide used during surgery? Many people don't......I
know I didn't. Had I understood, I know I would have never allowed Melissa
to have surgery in this manner. Do you wonder why you are worse after surgery
instead of better? I know everyone going in for surgery EXPECTS to be better
afterwards...or why would we take the risk?? KNOWLEDGE IS POWER!! I am
so very excited to share with everyone a powerful interview between Dr.
Kruschinski and Dr. Molinas. If you always delete messages that instruct
you to go to a web page and read or watch.......DON'T DELETE THIS ONE!!!!!
Take the time. Not only will you become informed, but you will feel you
are meeting Dr. Kruschinski. Dr. Kruschinski and Dr. Molinas are giving
us great insight into the effects of carbon dioxide usage during surgery.
Namely, explaining that carbon dioxide is a co- factor in adhesion formation.
You will also be informed that adhesions can be forming in OTHER areas
besides the area where the surgeon is working because of carbon dioxide
usage!! It is your body, your health at stake, please be informed before
you submit to surgery. Go to: http://www.endozone.comClick
on "congress coverage" Click on: "CO-2 and pneumoperitoneum problems w/laparoscopy"
(4-D) carbon dioxide info!
From: Karen Steward (kann@charter.net)
Mon Jun 2 23:13:46 2003 2 23:13:46 2003
http://www.adhesions.org/forums/ADHESIONS.0306/0009.html
Hi, I have some interesting information to share concerning the effects
of carbon dioxide. As many know, Dr. Kruschinski uses the AbdoLift system
when performing surgery to avoid the known troublesome causing effects
that CO2 leaves behind!! One known problem is shoulder pain. Many times
surgeons will prepare the patient for the expected shoulder pain--however
do they explain WHY you will have the shoulder pain? CO2 is also a known
contributor of adhesion formation! Please take time to read this informative
article! http://www.hcgresources.com/shoulderpain.html
It seems the AbdoLift technique is catching on..........patients are becoming
educated....... we should expect only the BEST when succumbing to surgery!
ARD is a debilitating condition that needs specific treatment by an informed
surgeon that takes into consideration ALL factors that will bring health
and healing to the patient. Many ARD patients have surgery over and over
again--but never become well~ My daughter was worse after both US surgeries.
She developed adhesion pain in areas she had not had problems before! Had
I known she was at risk for MORE adhesions, we would have never agreed
to surgery!! I am more than THRILLED to report she is WELL after our trip
to Germany and her surgery with Dr. Daniel Kruschinski. Many days I am
overcome with emotion. I still cannot believe it is true.....she is WELL!!
Best wishes to you all, Karen
(5) Research of Gasless Laps vs CO2
Laps!
(5-A) A randomized comparison of gasless
laparoscopy and CO2 pneumoperitoneum
Volume 224(6) December 1996 p 694 ...
Obstetrics & Gynecology 1997;90:416-420
© 1997 by The American College of Obstetricians
and Gynecologists
JM Goldberg and WG Maurer
OBJECTIVE: To determine if the theoretic advantages of gasless laparoscopy
are realized in direct comparison to laparoscopy with pneumoperitoneum.
METHODS: Fifty-seven patients undergoing laparoscopic surgery chose to
participate in this trial and were randomized after the induction of general
anesthesia. Twenty-nine of the 57 patients were randomized to the pneumoperitoneum
group. Of the 28 patients in the gasless group, six were converted to pneumoperitoneum
because of inadequate exposure. The adequacy of exposure and ease of surgery
were assessed with a subjective score, and the times to exposure and for
incision closure were recorded. Various anesthetic factors were measured.
Patients completed an analog pain score in the recovery area and for the
first 5 postoperative days. Analgesic and antiemetic use also was recorded,
as was the number of days to return to normal activity. RESULTS: Times
to achieve exposure and close incisions were longer, and exposure and ease
of surgery were worse in the gasless group. Patients in the gasless group
had lower diastolic blood pressure, minute ventilation, peak inspiratory
pressures, and end tidal pCO2. There were no differences in body temperature,
systolic blood pressure or heart rate, postoperative pain scores, analgesic
or antiemetic use, or times to hospital discharge or return to activity
between the groups. CONCLUSION: Performing laparoscopy using the Laparolift
device compromised surgical exposure and thus increased technical difficulty.
Patients realized no benefits from its use in terms of postoperative discomfort
or return to activity. Eliminating the pneumoperitoneum allowed lower minute
ventilation and peak inspiratory pressures, and end tidal pCO2 was lower.
Although the concept of gasless laparoscopy holds appeal, the current prototype
is not well-suited for infertility procedures. Full
Text (PDF) http://www.greenjournal.org/cgi/content/abstract/90/3/416
(5-B) Comparison of immune preservation
between CO2 pneumoperitoneum and gasless abdominal lift laparoscopy.
JSLS. 2002 Jan-Mar;6(1):11-5.
Department of Surgery, St. Mary's Hospital,
The Catholic University of Korea, Seoul. lizk@chollian.net
Kim WW, Jeon HM, Park SC, Lee SK, Chun SW,
Kim EK.
OBJECTIVE: Carbon dioxide (CO2) pneumoperitoneum
has been implicated as a possible factor in early immune preservation in
laparoscopic surgery. Although the current analysis was not adequate to
clarify this issue, the aim of this study was to compare CO2 insufflation
laparoscopic cholecystectomy to gasless abdominal wall lift laparoscopic
cholecystectomy with respect to preservation of the immune system. METHOD:
An analysis of the temporal immune responses was performed in 2 similar
groups of patients (n = 50) who were divided randomly into the categories
of gas or abdominal wall lift laparoscopic cholecystectomy. The patients
were matched with respect to age, weight, and operation time. The immune
parameters (serum white blood cell count, cortisol, erythrocyte sedimentation
rate [ESR], tumor necrosis factor-alpha [TNF-alpha], interferon-y [INF-gamma],
interleukin-6 [IL-6], interleukin-8 [IL-8]) were assessed at preoperative
24 hours and at postoperative 24 and 72 hours for the 2 groups. During
the operation, the levels of cytokines that were cultured in the peritoneal
macrophages were also checked. RESULTS: The serum white blood cell count,
cortisol, and ESR levels were not statistically different in either of
the 2 groups. Further, the serum TNF-alpha, INF-gamma, IL-6, and IL-8 levels
in both groups were not significantly different from each other at preoperative
24 hours, and postoperative 24 and 72 hours. However, an immediate decrease
in the cytokine levels at 24 hours after the operation was significant
in both groups. The cytokine levels were particularly higher in the cultured
peritoneal macrophages than in the serum, but were not statistically different
between the 2 groups. CONCLUSION: Our results showed that the beneficial
immune response obtained in the CO2 gas insufflation laparoscopic procedure
could also be obtained in the gasless abdominal wall lift laparoscopic
procedure. An immediate preservation of the immune functions in the postoperative
period was detected similarly in the 2 groups.
More:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12002290&dopt=Abstract
PMID: 12002290 [PubMed - indexed for MEDLINE]
(5-C) Gasless Laparoscopic
Assisted Hysterectomy with Epidural Anesthesia.
J Am Assoc Gynecol Laparosc 1994 Aug;1(4,
Part 2):S36
Topel HC
Lutheran General Hospital, 1875 Dempster, #245, Park Ridge, IL 60068.
Gasless laparoscopy is an evolving technique which can offer significant
advantages to both patient and surgeon. A variety of major laparoscopic
operations can be performed with gasless surgery including oophorectomy,
myomectomy, and hysterectomy. The use of conventional instrumentation and
open ports significantly improves the ease of surgery and greatly facilitates
techniques such as endosuturing. For those patients with a contraindication,
or a fear of general anesthesia, gasless laparoscopy under a regional anesthetic
is now a reasonable alternative. A laparoscopic-assisted vaginal hysterectomy
was performed with gasless technique under continuous epidural anesthesia.
The surgery was completed without complication, and the patient expressed
a high degree of satisfaction. Subsequently, three additional patients
have successfully undergone major laparoscopic operations using a gasless
technique and epidural anesthesia. With careful patient selection and attention
to proper technique, gasless laparoscopy under regional anesthesia is a
safe and viable alternative to conventional CO2 laparoscopy. More: http://www.csen.com/anesthesia/laparoscopy.htm
(6) Other comparisons between a
“CO2 Laporoscopic procedure & a gasless
Laporoscopic procedure”
(6-A) Smoke evacuation during electrosurgery
or CO2 laser laparoscopy is expedited using a Clear View EBS ICM ... Gasless
laparoscopy (abdominal wall retractors) ...
The International Society for Gynecologic Endoscopy (ISGE)
Harry Reich, M.D., F.A.C.O.G., FACS
Attending Physician, Wyoming Valley Health Care
System, Wilkes-Barre, PA
Corresponding Author:
Gasless laparoscopy (abdominal wall retractors)
Abdominal wall subcutaneous emphysema occurs frequently during anterior
abdominal wall adhesiolysis as peritoneal defects result in free communication
with the rectus sheath. This compromises peritoneal cavity operating space.
A useful technique is to insert an anterior abdominal wall retractor (AbdaLift,
Storz, CA) once the umbilicus has been cleared of adhesions.
More: www.isge.org/newshow.php?pid=136
(6-B) Changes in Hemodynamics and Autonomic
Nervous Activity in Patients Undergoing Laparoscopic Cholecystectomy: Differences
Between the Pneumoperitoneum and Abdominal Wall-Lifting Method Endoscopy
2002; 34: 643-650
DOI: 10.1055/s-2002-33252 1 Department of Gastroenterology,
National Kochi Hospital, Kochi, Japan
2 Second Department of Internal Medicine, School
of Medicine, University of Tokushima, Tokushima, Japan
3 Department of Nutrition, School of Medicine,
University of Tokushima, Tokushima, Japan
Background and Study Aims: Intraoperative
changes in circulatory hemodynamics and autonomic nervous activity were
evaluated in 33 patients with cholelithiasis who underwent laparoscopic
cholecystectomy. Patients and Methods: Of these patients, 18 were
treated using a pneumoperitoneum (group G) and 15 using the abdominal wall-lifting
method (group WL). Their ECG, blood pressure, arterial oxygen saturation,
and expiratory carbon dioxide partial pressure were monitored. Autonomic
nervous function was evaluated by spectral analysis of the heart rate.
Results:
Mean blood pressure increased significantly in group G during surgery,
but did not vary in group WL during any stage of surgery. The high-frequency
(HF) power, an index of parasympathetic activity, decreased significantly
in group G after pneumoperitoneum. However, the HF power did not decrease
significantly in group WL. The LF/HF ratio, an index of sympathetic activity,
increased significantly in group G after pneumoperitoneum, but did not
vary in group WL. In addition, the incidence of ventricular or supraventricular
arrhythmias and the severity of the arrhythmias as determined by Lown’s
classification were higher in group G than in group WL. These findings
suggest that intraoperative changes in autonomic nervous activity, due
to increased intra-abdominal pressure, were smaller in patients undergoing
laparoscopic cholecystectomy using the abdominal wall-lifting method than
in those undergoing laparoscopic cholecystectomy using pneumoperitoneum.
The results also demonstrated that hemodynamic changes were smaller in
patients undergoing the abdominal wall-lifting method than in those undergoing
pneumoperitoneum. Conclusions: It was concluded that hemodynamics
should be carefully monitored during pneumoperitoneum, and that the abdominal
wall-lifting approach in laparoscopic cholecystectomy is a method worthy
of consideration for elderly patients or those with cardiopulmonary complications.
More: http://www.thieme-connect.com/ejournals/abstract/endoscopy/doi/10.1055/s-2002-33252;jsessionid=16D2AF8CE6D8772E5DEF80946DFE1D5B.jvm1
(6-B) A Randomized, Prospective
Comparison of Pain after Gasless Laparoscopy and Traditional Laparoscopy
J Am Assoc Gynecol Laparosc. 1998
May;5 (2):149-53.
Guido RS, Brooks K, McKenzie R, Gruss J, Krohn
MA.
Magee-Womens Hospital, Pittsburgh, PA 15213-3180, USA.
STUDY OBJECTIVE: To compare pain after laparoscopic tubal ligation
by gasless laparoscopy versus carbon dioxide (CO2) pneumoperitoneum. DESIGN:
Prospective, randomized, single-blind comparison (Canadian Task Force classification
I). SETTING: Private obstetric-gynecology hospital associated with a university
resident teaching program. PATIENTS: Women age 21 to 42. INTERVENTION:
Single-puncture laparoscopic tubal ligation was performed with a silicone
elastomer band. Gasless laparoscopy was performed with a Laprolift and
traditional laparoscopy with CO2 pneumoperitoneum. Postoperative pain in
the shoulder and periumbilical and lower pelvic regions was measured by
visual analog scale on the day of surgery and postoperative days 1, 2,
3, 7, and 14. MEASUREMENTS and MAIN RESULTS: Of the 67 patients, 54 provided
visual analog scales for analysis, 30 in the gasless group and 24 in the
traditional group. No statistical difference was seen in scores for shoulder,
periumbilical, and pelvic pain between techniques. CONCLUSION: Patients
undergoing gasless laparoscopy and traditional laparoscopy experience similar
postoperative pain.
PMID: 9564062 [PubMed - indexed for MEDLINE]
More: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14507842&dopt=Abstract
Proceed with caution when securing an adhesiolysis from a surgeon,
or his patients, who claim to be “adhesion” specialists! NO MATTER who
it is, seek information from the surgeon ONLY and then seek substantiating
documentation of his procedures, such as: the number of adhesiolysis procedures
he has done, what IS the adhesiolysis procedure he uses, why does he think
it will offer you improvements in your symptoms, and what are the surgical
outcomes of his patients after 1 year or more!
NEVER take the word
of an ARD patient of ANY surgeon “specializing” in adhesions unless they
have secured improvements in their adhesion symptoms after
ONE year or more! Though each ARD case is
different, and there are different reasons for “pain after adhesiolysis,”
that are not
associated with adhesions, however, depending on the number of cases the
surgeon has performed, the amount of symptom relief each patents got
from a specific surgeon, and the length of time each patient has felt improvement
of their adhesion symptoms, and if all the right answers come back, then
you might want considered that surgeon. MOST important is to secure
validation of everything you hear from anyone!
There are just too many different posts
in and about Endogyn that contradict themselves to keep copying here, so
IHRT will simply ask you to go to this URL in Endogyn and study Daniel's
"case papers" for yourself. We are certain you will find these as informative
as anything else contained in Endogyn's ARD material and statistics!!
http://www.adhesions.de/index.php?seite=verw&sprache=en&a=Aboutadhesions&b=Questionablestudies
Go to: About adhesions
Go to:Dr.
K's case paper
Good Luck!
