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Invited Commentary

Albert K. Chin, MD
Arch Surg. 1997;132(2):169. doi:10.1001/archsurg.1997.01430260067015.
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The authors describe an elegant experimental study showing laparoscopic port-site tumor seeding in a gas insufflation environment; and, more important, a decreased incidence of seeding if insufflation is replaced with mechanical lifting of the abdominal wall. This finding indicates potential dependence of wound metastasis on spread of aerosol-borne tumor cells by active intra-abdominal gas flow, and suggests avoidance of pneumoperitoneum as a possible mechanism for avoiding this complication during laparoscopic cancer surgery.

Gasless laparoscopy is being applied by an international group of laparoscopic surgeons1-4 who recognize its benefits for facilitated instrument use, its ability to maintain an operating cavity in the face of continuous suction aspiration, and its utility in special applications such as pregnancy. The authors' suggestion that it may reduce the risk of entry-wound metastasis in tumor surgery to the levels achieved with open surgical resection carries substantial importance, because many patients may benefit from the reduced


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