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Comparing Low Pressure Versus High Pressure Pneumoperitoneum During Laparoscopic Cholecystectomy - Study

May 12, 2017

UroToday - The proper pressure for performing laparoscopy with the least impact on normal physiology and postoperative course continues to be debated. In this prospective study, 26 patients were randomized to a laparoscopic cholycystectomy at 8 mm vs. 12 mm. Among 13 patients in the 8 mm group, 30% required conversion to higher pressure; while the operative time and complications were no different between the two groups, surgeons found it more technically challenging to work at the lower pressure.

However, pain scales at 4, 8, and 24 hrs (23 vs. 11), use of analgesics (85% vs. 33%), pulmonary dysfunction, and hospital stay (43 hrs. vs. 27 hrs.) were all significantly less in the lower pressure than in the higher pressure group, respectively. Earlier work by Dexter and colleagues (Surg. Endosc. 13: 376, 1999) also showed better cardiac output at lower pressures (7mm) than at standard pressures. While this study did not address urine output, it has been shown that there is less oliguria as pressures are dropped below 15 mm Hg. to a level of 10 mm Hg.

In sum, when considering the pneumoperitoneum pressure, from the standpoint of patient well-being, "less is more." Working at levels below 10 mm Hg is recommended on the basis of improved homeostasis and convalescence.

Joshipura VP, Haribhakti SP, Patel NR, Naik RP, Soni HN, Patel B, Bhavsar MS, Narwaria MB, Thakker R
Surg Laparosc Endosc Percutan Tech. 2009 Jun;19(3):234-40
10.1097/SLE.0b013e3181a97012

UroToday Medical Editor Ralph V. Clayman, MD

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