The decreased operative space requires a more experienced surgeon and increases the learning curve. This exposure level was not sufficient for morbidly obese patients, men with very strong abdominal muscles, or those without good anesthesia. Abdominal respiration, which is not eliminated by EPA, produces a “tidal” up and down motion in the surgical field in some patients. To avoid injury to the small XL184 mw intestine, some procedures must be performed during the ebb. Furthermore,

gasless exposure is generally limited to a specific quadrant of the abdomen, which restricts exploration of the epigastric zone. It would be befitting to acknowledge the limitations of our study. First, our follow up was limited to 1 month postoperatively. Our aim was to look for early postoperative complications postdischarge. Second, the treatment allocation and clinical outcome assessment were not blinded. Third, fentanyl consumption may not be representative because PCA was only administered selleck chemical to those patients who asked to use it. Conclusions In our study, GLA and LA had comparable operative durations, complications, and total hospital stay lengths. However, GLA significantly reduced

the hospital cost. The demand for postoperative analgesics may also decrease following GLA. In conclusion, GLA is a safe and feasible procedure in selected patients. Future studies should assess GLA in elderly patients with chronic obstructive pulmonary disease.

It has been demonstrated that laparoscopic surgery is associated with a lower systemic stress response than open surgery, but intraperitoneal carbon dioxide insufflation attenuates peritoneal immunity [29]. Ultrastructural, Dichloromethane dehalogenase metabolic, and immune alterations are observed at the peritoneal surface in response to a pneumoperitoneum [30]. Therefore, gasless laparoscopy may preserve peritoneal immunity theoretically. But this also requires confirmation in future studies. Acknowledgement The project is supported by the National Natural Science Foundation of China (Grant No. 81100324) and The Department of Health of Shanghai (Grant No. 2010Y085). References 1. Semm K: Endoscopic appendectomy. Endoscopy 1983, 15:59–64.EVP4593 in vitro PubMedCrossRef 2. Nguyen NT, Zainabadi K, Mavandadi S, Paya M, Stevens CM, Root J, Wilson SE: Trends in utilization and outcomes of laparoscopic versus open appendectomy. Am J Surg 2004, 188:813–820.PubMedCrossRef 3. Laine S, Rantala A, Gullichsen R, Ovaska J: Laparoscopic appendectomy-is it worthwhile? A prospective, randomized study in young women. Surg Endosc 1997, 11:95–97.PubMedCrossRef 4. Egawa H, Morita M, Yamaguchi S, Nagao M, Iwasaki T, Hamaguchi S, Kitajima T, Minami J: Comparison between intraperitoneal CO2 insufflation and abdominal wall lift on QT dispersion and rate-corrected QT dispersion during laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 2006, 16:78–81.PubMedCrossRef 5.