Laparoscopy with artificial ascites.

Since September, 1985 we have performed laparoscopy with artificial ascites on 52 patients. First a laparoscopy with a pneumoperitoneum (2-31 CO2) is initiated, as usual under general anesthesia. After performing an orientating inspection, the CO2 is replaced by 2-31 warm physiological saline. The gas-containing intestinal loops, the air-containing stomach and the greater omentum float on the surface of the liquid, thus causing the mesenterium to spread out. By immersing the optical instrument in the liquid, accurate inspection of the intra-peritoneal organs becomes possible. By additionally inserting the optical instrument in the right upper quadrant, examination of the omental bursa can be performed. Tumors and adhesions in the posterior abdominal cavity and between neighboring organs can be seen, and with practice surgery is even possible. Further mastery of the new technique will provide additional diagnostic information. The indication for "second-look laparotomy" or "staging laparotomy" has now been made questionable by laparoscopy with artificial ascites.