Abstract
BackgroundNo definite consensus has been established about the optimal pressure for artificial pneumoperitoneum when performing laparoscopic surgery. It has been postulated that lowering intra-peritoneal pressure levels while performing general laparoscopic surgery would lower surgical complications including post-operative pain, but data remain scarce about significant operative complications. Furthermore, such data is not available for gynecologic laparoscopy. The objective of this systematic review is to compare the frequency and nature of significant operative complications of lower and standard pneumoperiteoneal pressure levels in gynecologic laparoscopic surgery for benign indications.Methods/designWe will search PubMed, Embase, the Cochrane Library, randomised control trials registries, and reference lists of included articles. Randomised controlled trials comparing different intra-peritoneal pressure levels in women undergoing gynecologic laparoscopic surgery for a non-malignant indication will be eligible. Two reviewers will independently select and review references, extract data, and assess quality from included studies. We will use RevMan5 to calculate risk ratios and their 95 % confidence intervals to compare the frequency of complications according to intra-peritoneal pressure levels. We will perform sensitivity analyses to explore heterogeneity potentially due to various operative characteristics or characteristics of patients.DiscussionOur results will help identify the optimal intra-peritoneal pressure level in gynecologic laparoscopic surgery and determine if lowering intra-peritoneal pressure levels while trying to achieve lower levels of post-operative pain is an acceptable change of practice according to the frequency and nature of significant complications.Systematic review registrationPROSPERO: CRD42015020231Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0091-6) contains supplementary material, which is available to authorized users.
Highlights
No definite consensus has been established about the optimal pressure for artificial pneumoperitoneum when performing laparoscopic surgery
In a recent systematic review, low intra-peritoneal pressures were associated with lower post-operative pain after cholecystectomy
Considering the need for more invasive surgery during the staging of potentially metastatic diseases and the obvious increased morbidity associated with these diseases, trials including more than 20 % of malignant indications for laparoscopy will be excluded
Summary
No definite consensus has been established about the optimal pressure for artificial pneumoperitoneum when performing laparoscopic surgery. It has been postulated that lowering intra-peritoneal pressure levels while performing general laparoscopic surgery would lower surgical complications including post-operative pain, but data remain scarce about significant operative complications. Such data is not available for gynecologic laparoscopy. It has been postulated that lowering pressures would reduce surgical complications such as post-operative pain, ventilation issues, and gas embolism [6, 7] This could result in increased bleeding, poorer visualisation, and exposure of the operative field, which may have a significant impact on the welfare of the patient. In a recent systematic review, low intra-peritoneal pressures were associated with lower post-operative pain after cholecystectomy
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