A Prospective Randomized, Controlled Study Comparing Low Pressure Versus High Pressure Pneumoperitoneum During Laparoscopic Cholecystectomy

Abstract

An uncomplicated gall stone disease can be treated by low pressure laparoscopic cholecystectomy with reasonable safety by an experienced surgeon. Though surgeons experience more difficulty in dissection during low pressure pneumoperitoneum, it is significantly advantageous in terms of postoperative pain, use of analgesics, preservation of pulmonary function, and hospital stay.

Feasibility and Safety of Low Pressure Pneumoperitoneum for Laparoscopic Cholecystectomy: A Prospective, Randomized, Triple-Blinded Trial

“…vision, space for dissection, and vision while using suction. They observed differences in favor of the higher pressure group in all three parameters, but these were not statistically significant [12]. In other studies, more than 85% of LCs were completed in patients randomized to the low pressure group.…”

“…As mentioned, this problem was partly circumvented by initially piercing the anterior abdominal fascia with a blade, and by sometimes using slightly oblique tracts. Anticipating this, others in similar situations have used a higher pressure initially for port placement [7,9,12,16]. We feel that the higher initial pressure might confound the cardiopulmonary variables in the LPLC group.…”

“…Only a few studies have dealt with comparison of cardiopulmonary parameters at different pressures of PP [7,8,12,20,21]. Wallace et al in a prospective, randomized doubleblinded study of 40 patients showed that there were no significant differences in intraoperative heart rate or cardiac index, although the latter fell significantly soon after insufflation in both groups.…”

“…Objective comparison of surgical difficulty at different pressures of PP has been performed by only one group [11,12]. Joshipura et al compared three parameters related to operative comfort, i.e.…”

“…liver function tests and cardiopulmonary parameters, have any clinical significance [11]. Joshipura and colleagues have performed the only randomized trial on the subject from our country; incidentally, they are also amongst the few to have commented on the operative challenges faced by reducing the pressure [12].…”