Offering Hope and Help to the Victims of ARD Worldwide

"The Endogate Papers"
    “IHRT is hoping that for once we are NOT correct in our stand regarding what appears to be "bogus" claims made to harvest persons afflicted with ARD to Endogyn, as if we are, many, far to many victims of ARD, have been victimized again......... We, at IHRT, DO in fact, proclaim ourselves the defenders of those afflicted with ARD, and we will continue our quest to stomp out the injustices dealt them wherever it continues to exist in the world, indeed as we are their defenders... PLEASE remember this if you do not go any further in this message!
   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!)

  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.) 

 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.

(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
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Gender: Male 
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)

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.
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


(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
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Registered: Jul 2003 
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Posts: 253
Laparoscopic surgery does NOT reduce adhesions !!!
Posted Wednesday, October 8, 2003 @ 12:38 PM
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 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...

(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!
Tonya’s story:

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 
Registered: Jul 2003 
Status: Offline 
Posts: 253 
Posted Wednesday, October 8, 2003 @ 12:40 PM
Comment on adhesion formation by using carbon dioxide gas .....
"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 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: 
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 
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 ...
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 (
Sun May 18 22 
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 (
Mon Jun 2 23:13:46 2003 2 23:13:46 2003
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! 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)

(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.
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. 
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:


(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:

(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.

  (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] 

  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!!
Go to: About adhesions            Go to:Dr. K's case paper

Good Luck!

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