The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery

Abstract

Preoperatively, all patients should be assessed for the presence of cardiac, pulmonary, hepatic, renal, or vascular comorbidity. Presupposing appropriate perioperative measures and surgical technique, there is no reason to contraindicate pneumoperitoneum in patients with peritonitis or intraabdominal malignancy. During laparoscopy, monitoring of end tidal CO2 concentration is mandatory. The available data on closed- (Veress needle) and open-access techniques do not allow us to principally favor the use of either technique. Using 2 to 5-mm instead of 5 to 10-mm trocars improves cosmetic result and postoperative pain marginally. It is recommended to use the lowest intraabdominal pressure allowing adequate exposure of the operative field, rather than using a routine pressure. In patients with limited cardiac, pulmonary, or renal function, abdominal wall lifting combined with low-pressure pneumoperitoneum might be an alternative. Abdominal wall lifting devices have no clinically relevant advantages compared to low-pressure (5-7 mmHg) pneumoperitoneum. In patients with cardiopulmonary diseases, intra- and postoperative arterial blood gas monitoring is recommended. The clinical benefits of warmed, humidified insufflation gas are minor and contradictory. Intraoperative sequential intermittent pneumatic compression of the lower extremities is recommended for all prolonged laparoscopic procedures. For the prevention of postoperative pain a wide range of treatment options exists. Although all these options seem to reduce pain, the data currently do not justify a general recommendation.

Evaluation of quality of life after laparoscopic surgery: evidence-based guidelines of the European Association for Endoscopic Surgery

“…In addition, the pediatric aspects of some of these diseases were addressed. The Cologne Group was asked to organize a CDC, according to previously established methodology [86]. For this purpose, the methods of a systematic review and a CDC were combined.…”

Laparoscopic Cholecystectomy in Patients with Cardiac Dysfunction

“…Most of the studies addressing cardiovascular effects of CO 2 pneumoperitoneum have been performed in healthy subjects, who seem to tolerate pneumoperitoneum without untoward problem [14,15,20]. Similar issues have not been studied under the setting of randomized trial in patients with cardiac co-morbidities [21]. May be hence, there is considerable reticence among surgeons in performing laparoscopy in patients with compromised heart.…”

“…Some study define 'normal' insufflation pressure as 12-15 mmHg and a 'low' pressure as 5-7 mmHg [21] while a recent review arbitrarily considered anything less than 12 mmHg as low pressure [33]. Studies in healthy individuals have shown less pronounced decrease in cardiac index using low pressure peritoneal insufflation, while the pulmonary parameters have remained more or less similar in both the groups [13,34,35].…”

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