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. 2016 Jan-Mar;20(1):e2015.00113.
doi: 10.4293/JSLS.2015.00113.

Low vs Standard Pressures in Gynecologic Laparoscopy: a Systematic Review

Esther B Kyle  1 , Sarah Maheux-Lacroix  1 , Amélie Boutin  1 , Philippe Y Laberge  1 , Madeleine Lemyre  1
Affiliations

Low vs Standard Pressures in Gynecologic Laparoscopy: a Systematic Review

Esther B Kyle et al. JSLS. 2016 Jan-Mar.

Abstract

Background: The optimal intraperitoneal pressure during laparoscopy is not known. Recent literature found benefits of using lower pressures, but the safety of doing abdominal surgery with low peritoneal pressures needs to be assessed. This systematic review compares low with standard pneumoperitoneum during gynecologic laparoscopy.

Database: We searched Medline, Embase, and the Cochrane Library for randomized controlled trials comparing intraperitoneal pressures during gynecologic laparoscopy. Two authors reviewed references and extracted data from included trials. Risk ratios, mean differences, and standard mean differences were calculated and pooled using RevMan5. Of 2251 studies identified, three were included in the systematic review, for a total of 238 patients. We found a statistically significant but modest diminution in postoperative pain of 0.38 standardized unit based on an original 10-point scale (95% confidence interval [CI], -0.67 to -0.08) during the immediate postoperative period when using low intraperitoneal pressure of 8 mm Hg compared with ≥ 12 mm Hg and of 0.50 (95% CI, -0.80 to -0.21) 24 hours after the surgery. Lower pressures were associated with worse visualization of the surgical field (risk ratio, 10.31; 95% CI, 1.29-82.38). We found no difference between groups over blood loss, duration of surgery, hospital length of stay, or the need for increased pressure.

Conclusion: Low intraperitoneal pressures during gynecologic laparoscopy cannot be recommended on the behalf of this review because improvement in pain scores is minimal and visualization of the surgical field is affected. The safety of this intervention as well as cost-effectiveness considerations need to be further studied.

Keywords: Artificial pneumoperitoneum; Gynecology; Laparoscopy; Pain; Safety.

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Figures

Figure 1.
Figure 1.
Flow diagram.
Figure 2.
Figure 2.
Abdominal pain ≤ 6 h after surgery.
Figure 3.
Figure 3.
Abdominal pain 24 h after surgery.
See this image and copyright information in PMC

References

    1. Neudecker J, Sauerland S, Neugebauer E, Bergamaschi R, Bonjer HJ, Cuschieri A, et al. The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery. Surg Endosc. 2002;16(7):1121–1143. doi:. - DOI - PubMed
    1. la Chapelle CF, Bemelman WA, Rademaker BM, van Barneveld TA, Jansen FW. A multidisciplinary evidence-based guideline for minimally invasive surgery: Part 1: entry techniques and the pneumoperitoneum. Gynecol Surg. 2012;9(3):271–282. - PMC - PubMed
    1. Galizia G, Prizio G, Lieto E, Castellano P, Pelosio L, Imperatore V, et al. Hemodynamic and pulmonary changes during open, carbon dioxide pneumoperitoneum and abdominal wall-lifting cholecystectomy. A prospective, randomized study. Surg Endosc. 2001;15(5):477–483. doi:. - DOI - PubMed
    1. Leonard IE, Cunningham AJ. Anaesthetic considerations for laparoscopic cholecystectomy. Best Pract Res Clin Anaesthesiol. 2002;16(1):1–20. - PubMed
    1. Henny CP, Hofland J. Laparoscopic surgery: pitfalls due to anesthesia, positioning, and pneumoperitoneum. Surg Endosc. 2005;19(9):1163–1171. doi:. - DOI - PubMed

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