CONTROVERSIES IN LOW VERSUS STANDARD PRESSURE PNEUMOPERITONEUM USAGE IN LAPAROSCOPIC SURGERIES
Keywords:
Laparoscopic surgery, pneumoperitoneum
Abstract
Background: Laparoscopic surgery has evolved over a past few decades and continues to advance. When compared with open surgeries, laparoscopic surgeries have several advantages of faster recovery and decreased postoperative pain. The workplace so created by pneumoperitoneum has its negative implications on cardiovascular, pulmonary and intrabdominal organ functioning. Several trials have been done to see these impacts using low pressure and standard pressure pneumoperitoneum. Recently attention is focused on improving clinical outcomes based on altering the laparoscopic surgical environment.
Methods: Systematic review of all randomized controlled clinical trials and observational studies comparing low versus standard pressure pneumoperitoneum. Results and
Conclusions: In healthy individuals undergoing laparoscopic procedures, limited data are available to suggest supremacy of low-pressure pneumoperitoneum over standard pneumoperitoneum. However certain parameters seem to have an impact with low-pressure pneumoperitoneum but to generalize at present with lack of significant randomized controlled clinical trials would be inappropriate. One can safely conclude that low-pressure settings does seem to reduce postoperative pain and would be safer in patients with the high-risk group but in lowrisk patients using low-pressure settings would risk the safety with regard to workspace and dissection.
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References
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8. Bourdel N et al. Peritoneal tissue oxygen tension during a carbon dioxide pneumoperitoneum in a mouse laparoscopic model with controlled respiratory support. Hum Reprod 2007; 22:1149-1155
9. Wittich P et al. Intraperitoneal tumor growth is influenced by the pressure of carbon dioxide pneumoperitoneum. Surg Endosc 2000; 14:817-819
10. Matsuzaki S et al. Molecular mechanisms underlying postoperative peritoneal dissemination might differ between a laparotomy and a CO2
pneumoperitoneum: a syngeneic mouse model with controlled respiratory support. Surg Endosc 2009;23:705-714
11. Matsuzaki S et al. Impact of the intraperitoneal pressure of a CO2 pneumoperitoneum on the surgical peritoneal environment. Hum Reprod 2012; 27(6):1613-1623
12. Loring SH et al. Respiratory mechanical effects of surgical pneumoperitoneum in humans. J Appl Physiol 2014; 117:1074-1079
13. Karagulle E et al (2008) The effects of different abdominal pressures on pulmonary function test results in laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 18(4):329-333
14. Eryilmaz HB et al (2012) The effects of different insufflation pressures on liver functions assessed with LEMON in patients undergoing laparoscopic
cholecystectomy. Sci World J 2012: 172575
15. Dexter SP et al (1999) Hemodynamic consequences of High- and lowpressure capnoperitoneum during laparoscopic cholecystectomy. Surg Endosc 13(4):376-381
16. Ekici Y et al (2009) Effect of different intra-abdominal pressure levels on QT dispersion in patients undergoing laparoscopic cholecystectomy. Surg Endosc 23(11):2543-2549
17. Sood J et al (2006) laparoscopic approach to pheochromocytoma: is a lower abdominal pressure helpful? Anesth Analg 102(2):637-641
18. Koivusalo AM et al (2008) Laparoscopic cholecystectomy with carbon dioxide pneumoperitoneum is safe even for high-risk patients. Surg Endosc 22(1):61-67
19. Delius SV et al. Natural –orifice transluminal endoscopic surgery: low – pressure pneumoperitoneum is sufficient and is associated with an improved cardiopulmonary response (Pressure Pig study) Endosc 2011 sep; 43(9):808-15.PMID 21732271
20. Hasukic S (2005) Postoperative changes in liver function tests: a randomized comparison of low- and high-pressure laparoscopic cholecystectomy. Surg Endosc
19(11):1451-1455
21. Morino M et al (1998) Alterations in hepatic function during laparoscopic surgery. An experimental clinical study. Surg Endosc 12(7):968-972
22. Jae Yeon Lee, Seok Hwa Choi. Results of hepatic and renal function test to different CO2 pneumoperitoneum conditions: An experimental capnoperitoneum study in dogs. Research in Veterinary Science 2015 Aug; 101:1-5.PMID:26267080
23. Hawasli A et al (2003) The effect of pneumoperitoneum on kidney function in laparoscopic donor nephrectomy. Am Surg 69(4): 300-303 (discussion 303)
24. Rist M et al 2001 Influence of pneumoperitoneum and patient positioning on preload and splanchnic blood volume in laparoscopic surgery of the lower abdomen. J Clin Anesth 13(4):244-249
25. Ido K et al(1995) Femoral vein stasis during laparoscopic cholecystectomy: effects of graded elastic compression leg bandages in preventing thrombus formation. Gastrointestinal Endosc 42(2):151-155
26. Eric EC et althea effects of low – pressure carbon dioxide pneumoperitoneum on cerebral oxygenation and cerebral blood volume in children. Anesth Analg
2002 Mar; 94(3): 500-5; table of contents. PID 11867365
27. Kamine TH et al (2014) Effect of abdominal insufflation for a laparoscopy on intracranial pressure. JAMA Surg 149(4):380-382
28. Hwang JW et al (2013) Does intraocular pressure increase during laparoscopic surgeries? It depends on anesthetic drugs and the surgical position. Surg Laparosc Endosc Percutan Tech 23(2): 229-232
29. Yoo YC et al (2014) Increase in intraocular pressure is less with propofol than with sevoflurane during laparoscopic surgery in the steep tredenlenbergs position. Can J Anaesth 61(4): 322-329
30. Anne K Stachr- Rye et al. Deep Neuromuscular blockade rather than moderate muscular relaxation. Anesth Analg 2014 Nov; 119 (5): 1084-92.PMID:24977638
31. Bogani G et al (2014) Low vs. standard pneumoperitoneum pressure during laparoscopic hysterectomy: prospective randomized trial. J Minim Invasive Gynecol 21(3):466-471.
2. Gurusamy KS et al (2009) Low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy. Cochrane Database Syst Rev 2: CD006930
3. Bisgaard T et al (2001) Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain 90 (3): 261-269
4. Joshipura VP et al (2009) A prospective randomized, controlled study comparing low pressure versus highpressure pneumoperitoneum during laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 19(3):234-240
5. Bhattacharjee HK et al.Impact of standard pressure and low –pressure pneumoperitoneum on shoulder pain following laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc 2016 July 21; PMID 27444831
6. Vijayaraghavan N et al. Comparison of standard- pressure and low – pressure pneumoperitoneum in laparoscopic cholecystectomy: a double-blinded randomized controlled study. Surg Laparosc, Endosc Percutan Tech 2014 Apr; 24(2):127-33. PMID 24686347
7. Warle MC et al (2013) Low –pressure pneumoperitoneum during laparoscopic donor nephrectomy to optimize live donors’ comfort. Clin Transplant 27(4) :E478-E483
8. Bourdel N et al. Peritoneal tissue oxygen tension during a carbon dioxide pneumoperitoneum in a mouse laparoscopic model with controlled respiratory support. Hum Reprod 2007; 22:1149-1155
9. Wittich P et al. Intraperitoneal tumor growth is influenced by the pressure of carbon dioxide pneumoperitoneum. Surg Endosc 2000; 14:817-819
10. Matsuzaki S et al. Molecular mechanisms underlying postoperative peritoneal dissemination might differ between a laparotomy and a CO2
pneumoperitoneum: a syngeneic mouse model with controlled respiratory support. Surg Endosc 2009;23:705-714
11. Matsuzaki S et al. Impact of the intraperitoneal pressure of a CO2 pneumoperitoneum on the surgical peritoneal environment. Hum Reprod 2012; 27(6):1613-1623
12. Loring SH et al. Respiratory mechanical effects of surgical pneumoperitoneum in humans. J Appl Physiol 2014; 117:1074-1079
13. Karagulle E et al (2008) The effects of different abdominal pressures on pulmonary function test results in laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 18(4):329-333
14. Eryilmaz HB et al (2012) The effects of different insufflation pressures on liver functions assessed with LEMON in patients undergoing laparoscopic
cholecystectomy. Sci World J 2012: 172575
15. Dexter SP et al (1999) Hemodynamic consequences of High- and lowpressure capnoperitoneum during laparoscopic cholecystectomy. Surg Endosc 13(4):376-381
16. Ekici Y et al (2009) Effect of different intra-abdominal pressure levels on QT dispersion in patients undergoing laparoscopic cholecystectomy. Surg Endosc 23(11):2543-2549
17. Sood J et al (2006) laparoscopic approach to pheochromocytoma: is a lower abdominal pressure helpful? Anesth Analg 102(2):637-641
18. Koivusalo AM et al (2008) Laparoscopic cholecystectomy with carbon dioxide pneumoperitoneum is safe even for high-risk patients. Surg Endosc 22(1):61-67
19. Delius SV et al. Natural –orifice transluminal endoscopic surgery: low – pressure pneumoperitoneum is sufficient and is associated with an improved cardiopulmonary response (Pressure Pig study) Endosc 2011 sep; 43(9):808-15.PMID 21732271
20. Hasukic S (2005) Postoperative changes in liver function tests: a randomized comparison of low- and high-pressure laparoscopic cholecystectomy. Surg Endosc
19(11):1451-1455
21. Morino M et al (1998) Alterations in hepatic function during laparoscopic surgery. An experimental clinical study. Surg Endosc 12(7):968-972
22. Jae Yeon Lee, Seok Hwa Choi. Results of hepatic and renal function test to different CO2 pneumoperitoneum conditions: An experimental capnoperitoneum study in dogs. Research in Veterinary Science 2015 Aug; 101:1-5.PMID:26267080
23. Hawasli A et al (2003) The effect of pneumoperitoneum on kidney function in laparoscopic donor nephrectomy. Am Surg 69(4): 300-303 (discussion 303)
24. Rist M et al 2001 Influence of pneumoperitoneum and patient positioning on preload and splanchnic blood volume in laparoscopic surgery of the lower abdomen. J Clin Anesth 13(4):244-249
25. Ido K et al(1995) Femoral vein stasis during laparoscopic cholecystectomy: effects of graded elastic compression leg bandages in preventing thrombus formation. Gastrointestinal Endosc 42(2):151-155
26. Eric EC et althea effects of low – pressure carbon dioxide pneumoperitoneum on cerebral oxygenation and cerebral blood volume in children. Anesth Analg
2002 Mar; 94(3): 500-5; table of contents. PID 11867365
27. Kamine TH et al (2014) Effect of abdominal insufflation for a laparoscopy on intracranial pressure. JAMA Surg 149(4):380-382
28. Hwang JW et al (2013) Does intraocular pressure increase during laparoscopic surgeries? It depends on anesthetic drugs and the surgical position. Surg Laparosc Endosc Percutan Tech 23(2): 229-232
29. Yoo YC et al (2014) Increase in intraocular pressure is less with propofol than with sevoflurane during laparoscopic surgery in the steep tredenlenbergs position. Can J Anaesth 61(4): 322-329
30. Anne K Stachr- Rye et al. Deep Neuromuscular blockade rather than moderate muscular relaxation. Anesth Analg 2014 Nov; 119 (5): 1084-92.PMID:24977638
31. Bogani G et al (2014) Low vs. standard pneumoperitoneum pressure during laparoscopic hysterectomy: prospective randomized trial. J Minim Invasive Gynecol 21(3):466-471.
How to Cite
1.
Dr Priyanka Suhag, Dr Abhishek Chandavarkar. CONTROVERSIES IN LOW VERSUS STANDARD PRESSURE PNEUMOPERITONEUM USAGE IN LAPAROSCOPIC SURGERIES. Med. res. chronicles [Internet]. 2017Oct.31 [cited 2024May7];4(05):521-6. Available from: https://medrech.com/index.php/medrech/article/view/270
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Review Article
