Low-pressure Laparoscopic Cholecystectomy Research Articles

Comparison of low-pressure and standard-pressure pneumoperitoneum laparoscopic cholecystectomy in patients with cardiopulmonary comorbidities: a double blinded randomized clinical trial

BackgroundThe benefits of low-pressure laparoscopic cholecystectomy (LPLC) in patients with cardiopulmonary comorbidities remain unclear. This study aimed to explore the feasibility and pulmonary effects of LPLC in patients with cardiopulmonary comorbidities.MethodsThis was a multicenter, parallel, double-blind, randomized controlled trial. Eligible patients included patients with cardiac or pulmonary comorbidities, who were randomly assigned (1:1) to undergo LPLC (10 mmHg) or standard-pressure laparoscopic cholecystectomy (SPLC) (14 mmHg). The primary outcome was postoperative partial pressure of carbon dioxide (CO2). Surgical safety variables, patient recovery, pulmonary function parameters, and surgeon comfort were also compared between groups.ResultsThis study enrolled 144 participants, with 124 participants extracted for the final analysis (62 in LPLC and 62 in SPLC group, respectively). The median postoperative PaCO2 was similar in the LPLC (43.3 mmHg) and SPLC (43.0 mmHg) groups (p = 0.988). Pulmonary parameters including postoperative pH, PaCO2, HCO3, and lactate levels were similar between the two groups. Postoperative base excess was significantly higher in the LPLC group (− 0.6 mmol/L [− 6.9 ~ 7.5] vs. −1.9 mmol/L [− 6.6 ~ 5.4]; p = 0.031). There was no between-group difference regarding intraabdominal operative time, rate of intraoperative bile spillage, blood loss, surgeon comfort during surgery, and conversion rate. Moreover, postoperative major complication rates, the median time to the first flatus, postoperative hospital stay, or mean postoperative visual analog scale score for pain were similar in both groups.ConclusionsThis study found no reduction of partial pressure of CO2 with LPLC compared with SPLC for patients with cardiopulmonary comorbidities. LPLC with a pneumoperitoneum pressure of 10 mmHg may be safe and feasible for these patients when performed by experienced surgeons, although it does not improve pulmonary parameters.RegistrationThe trial is retrospectively registered at ClinicalTrials.gov (NCT04670952) on December 17, 2020.

A randomised clinical trial to study postoperative abdominal and shoulder tip pain following low and standard pressure laparoscopic cholecystectomy

BackgroundLaparoscopic cholecystectomy (LC) has become the gold standard for the management of symptomatic gallstone disease. The complications related to different pressure ranges of pneumoperitoneum have been studied widely with no definite conclusion till date. The current study was planned to determine the effect of standard versus low pressure laparoscopic cholecystectomy (LPLC) on postoperative abdominal and shoulder tip pain (STP). MethodsThe present randomised clinical trial included 84 patients divided into two groups: standard pressure laparoscopic cholecystectomy (SPLC) (13 mmHg) and LPLC (9 mmHg). The variables tested were abdominal pain at 3, 6, 12 and 24 h (by verbal rating scale), the incidence and intensity of STP, post-operative nausea and vomiting (PONV) and surgeon's comfort for the two techniques. ResultsThe demographic characteristics of patients were similar in both groups. In LPP group, the postoperative abdominal pain at 6, 12 and 24 h was significantly less than SPLC; p = 0.02. Incidence of shoulder pain was significantly less in low pressure group (7.14%) compared with standard pressure (28.57%). ConclusionsLow-pressure pneumoperitoneum (LPP) is safe and feasible surgery with reduced abdominal and STP.

An observational study on the effect of high versus low carbon dioxide pressure in laparoscopic cholecystectomy

Background: Gall bladder stone is one of the common diseases of hepatobiliary system. If it is symptomatic then it needs to be treated and sometimes it may lead to multiple complications. Laparoscopic approach for cholecystectomy is widely acceptable and routinely done procedure for gall bladder stone. Laparoscopic cholecystectomy reduces postoperative pain and hospital stay as compared to open surgery. Laparoscopic surgeries require carbon dioxide (CO2) to inflate peritoneal cavity.Methods: It is an observational study at tertiary care centre. In present study authors have included all patients undergoing elective laparoscopic cholecystectomy. Patients required conversion to open cholecystectomy from laparoscopic cholecystectomy and emergency laparoscopic cholecystectomy and laparoscopic cholecystectomy for malignancy were not included. In present study, patients were randomly allocated into two groups: group A (n=50) low CO2 pressure (8-10 mmHg) pneumoperitonium and group B (n=50) high CO2 pressure (12-14 mmHg) pneumoperitonium to perform laparoscopic cholecystectomy. In present study authors have compared post operative effects in term of pain (at 4, 8 and 12 hrs post operatively), hospital stay and requirements of injectable analgesics between group A and group B.Results: 14 patients in group B complained of post operative shoulder tip pain as compared to only 5 patients in group A. Analgesic requirement and mean length of post operative hospital stay were also less in group A as compared to group B.Conclusions: Low pressure laparoscopic cholecystectomy (LPLC) significantly decrease the frequency and intensity of post operative shoulder tip pain. So, LPLC decrease the demand for postoperative analgesics and decrease post operative hospital stay.

Comparison of Optic Nerve Sheath Diameter (ONSD) in Low-Pressure Versus Normal Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy: A Randomized Clinical Study.

Background: Low pressure laparoscopic cholecystectomy has been advocated due to reduction in postoperative pain, ventilation problems, hemodynamic complications, and potential for reduction in surgical events. No reported data have been found focusing on the effects of low-pressure laparoscopic cholecystectomy on intracranial pressure (ICP). The aim of this study was to investigate the effect of low-pressure laparoscopic cholecystectomy on intracranial pressure measured by optic nerve sheath diameter (ONSD) in Imam Hossein Medical Center, Tehran, Iran. Methods: The patients classified as American Society of Anesthesiologists physical status I or II undergoing elective laparoscopic cholecystectomy due to benign gallbladder disease were randomly assigned to low-pressure laparoscopy (LPL) group or normal pressure laparoscopy group (NPL). ONSD was measured at 3 different times: (1) before induction of anesthesia; (2) after initiation of gas insufflation; and (3) after the termination of gas insufflation. The collected data were entered into SPSS software (V 24). Data were demonstrated with frequency (percentage) or mean ± standard deviation. We used the Mann-Whitney test to compare the means of continuous variables. The Friedman test was used to compare the mean of variables over time in each of the 2 groups. The significance level in all analyses was considered at ˂0.05. Results: ONSD after the termination of gas insufflation was significantly lower in the LPL group with the mean of 4.97±0.83 mm than the NPL group with the mean of 5.62±1.32 mm (p=0.018). ONSD before induction of anesthesia or immediately after gas insufflation did not differ significantly between LPL and NPL groups. Duration of anesthesia and surgery, mean arterial pressure, the total dose of propofol (p=0.600), and fentanyl (p=0.201) did not show significant differences between the 2 groups. Conclusion: ONSD was lower with low-pressure laparoscopic cholecystectomy after the termination of gas insufflation, which emphasized the neural protective effect of low intraperitoneal pressure. Further studies are needed to evaluate this diagnostic tool in different populations, especially in patients with increased ICP undergoing laparoscopic interventions.

EVALUATION OF POSTOPERATIVE SHOULDER TIP PAIN IN LOW PRESSURE VERSUS STANDARD PRESSURE PNEUMOPERITONEUM DURING LAPAROSCOPIC CHOLECYSTECTOMY

Introduction:- Insufation of carbon dioxide during laparoscopic cholecystectomy carries on to postoperative shoulder tip pain. The beginning of shoulder pain is commonly presumed to be due to overstretching of the diaphragmatic muscle bres due to high carbon dioxide pressure. Methods: - Patients came and admitted to the surgery department for elective cholecystectomy were enrolled in the study. The patients were randomly divided in two groups (group A and group B). In group A - low-pressure pneumoperitoneum (8 mm Hg) and in group B- standard pressure pneumoperitoneum (14 mm Hg) was created during laparoscopic cholecystectomy. Postoperative shoulder tip pain was evaluated at 4 hours and 24 hours after the operation. Results:- Fourteen patients or 28 % of patients in group B complained of postoperative shoulder tip pain as collated to only ve patients (10%) in group A. The mean intensity of postoperative shoulder tip pain assessed by the visual analogue scoring scale at 4 hours and 24 hours was less in group A as collated to group B. However, statistical signicance was seen only at four hours. Analgesic requirements and the mean length of postoperative stay in the hospital were minor in group-A as collated to group B. Conclusion: - Low-pressure laparoscopic cholecystectomy signicantly reduces the frequency and intensity of postoperative shoulder tip pain. Low-pressure laparoscopic cholecystectomy decreases the demand for postoperative analgesics, decreases postoperative hospital stay, and improves the quality of life in the initial stage of postoperative rehabilitation.

A Randomized Trial of Low-Pressure (08–10 mm Hg) vs. Standard-Pressure (13–15 mm Hg) Pneumoperitoneum in Laparoscopic Cholecystectomy

The reported incidence of shoulder tip pain after laparoscopic cholecystectomy was 30%–50%. The aim of the present randomized controlled study was to compare the effects of low-pressure (08–10 mm Hg) vs. standard-pressure (13–15 mm Hg) pneumoperitoneum in patients undergoing laparoscopic cholecystectomy. One hundred patients between 18 and 70 years undergoing laparoscopic cholecystectomy were included. Group A and group B patients underwent low-pressure and standard-pressure pneumoperitoneum laparoscopic cholecystectomy respectively. Post-operative shoulder tip pain and post-operative abdominal pain were measured using visual analogue scale score at 2 h, 8 h, 24 h and 48 h after surgery. The primary outcome measures were the incidence and severity of post-operative shoulder tip pain, whereas secondary outcome measures were the incidence and severity of abdominal pain. Intergroup comparison of categorical and continuous variables was done using the chi-square test/Fisher’s exact test and unpaired ‘t’ test respectively. The incidence and severity of post-operative shoulder tip pain at 2 h, 8 h, 24 h and 48 h was significantly higher in group B as compared to group A. The incidence of post-operative abdominal pain at 48 h was significantly higher in group B as compared to group A. The severity of post-operative abdominal pain at 24 h and 48 h was significantly higher in group B as compared to group A. Low-pressure laparoscopic cholecystectomy significantly decreases the incidence and severity of post-operative shoulder tip and abdominal pain. Routine use of low-pressure pneumoperitoneum for the alleviation of post-operative pain following laparoscopic cholecystectomy is recommended.

Feasibility of the Ultravision™ System in Low Pressure Laparoscopic Cholecystectomy Compared to Airseal® IFS

Feasibility of the Ultravision™ System in Low Pressure Laparoscopic Cholecystectomy Compared to Airseal® IFS

Prospective randomised trial of standard pressure versus low pressure laparoscopic cholecystectomy in a tertiary care hospital from Kolkata: Our experience

Background: Laparoscopic cholecystectomy (LC), the procedure of choice for symptomatic gall stone disease. An emerging trend is to perform Low pressure pnuemoperitonium laparoscopic surgery as it has additive advantages over standard pressure to avoid complications while providing adequate working space.Aims and Objectives: The current study was designed with an aim to compare the advantage of low pressure pneumoperitoneum vs standard pressure pneumoperitoneum in laparoscopic cholecystectomy.Materials and Methods: The study was conducted in the department of General Surgery in R.G.Kar Medical College from January 2014 to June 2015. A total of 52 patients with symptomatic gall stone disease were recruited, 26 patients in each group randomly. Some intraoperative and post-operative parameters were studied.Results: All the intra-operative (IO) cardio-respiratory parameters (Pulse, Mean Arterial Pressure (MAP), End tidal CO2, spO2) were recorded just before incision, 20 minutes intra-operatively and before reversal of general anesthesia (GA). The IO parameters in our study, were found to be significant only at 20 minutes IO and before reversal of GA. The post-operative (PO) parameters (Pulse, MAP, Respiratory rate, spO2) and pain by VAS score at 6 hours, 12 hours and 24 hours post-operatively were studied. In PO period, we observed significant differences at 2 hours post-operatively in all parameters except MAP. There was significant difference in pain at 6, 12 and 24 hours when compared in both groups. The shoulder tip pain (STP) and 2 hours PO nausea and vomiting were found to be significantly higher in Standard pressure Laparoscopic cholecystectomy (SPLC) compared to Low pressure Laparoscopic cholecystectomy (LPLC). The operative time, duration of hospital stay and return to normal life after surgery though had differences but it was statisticallyinsignificant.Conclusion: Low pressure laparoscopic surgery is safe with least post operative complications when performed by experienced surgeons even in patients of ASA III.Asian Journal of Medical Sciences Vol.9(4) 2018 17-22

Comparative evaluation of hemodynamic and capnographic changes in low pressure versus normal pressure pneumoperitoneum in laparoscopic cholecystectomy

Background: In laparoscopic cholecystectomy (LC), the extent of hemodynamic changes associated with creation of pneumoperitoneum depends on the intra-abdominal pressure attained, volume of CO2 absorbed, and patient’s intravascular volume. In our study, we attempted to compare the hemodynamic and capnographic changes in the low pressure (<8mm Hg) and standard pressure (12-14mm Hg) LC.Methods: In this randomized case control study, Group A included patients undergoing Low pressure LC (<8mm Hg). In group B, Standard pressure LC (12-14mmHg) was performed. Both groups were evaluated for the hemodynamic and capnographic changes and other parameters.Results: Difference in mean heart rate of Group A and Group B was found to be statistically significant at 10 min after induction. After 30 minutes of surgery, systolic blood pressure of Group B was found to be higher than that of Group A (p <0.05). Differences in diastolic blood pressure among patients of Group A and Group B were found to be statistically significant only at 30 min and 40 min after induction. Except at 30 min after induction, differences in EtCO2 levels of patients of Group A and Group B were found to be statistically significant.Conclusions: It appears that low pressure pneumoperitoneum appears to be having fewer effects on blood pressure- both systolic and diastolic, as compared to standard pressure pneumoperitoneum in patients undergoing LC. It also appears to be causing fewer derangements in ETCO2. This may help in smooth recovery and less post-operative problems.

Comparing Hemodynamic Symptoms and the Level of Abdominal Pain in High- Versus Low-Pressure Carbon Dioxide in Patients Undergoing Laparoscopic Cholecystectomy.

The laparoscopic cholecystectomy (LC) is the gold standard to treat gallstone. To view the surgical site in this type of operations better, carbon dioxide is used with a certain pressure. The current study aimed to compare the hemodynamic symptoms and the level of abdominal pain due to using high- and low-pressure carbon dioxide in patients undergoing LC. The current double-blind randomized clinical trial was conducted on 60 patients with the age range of 20-70years old undergoing LC. The first and second groups experienced PaCO2 of 7-10 and 12-14mmHg, respectively. The hemodynamic symptoms, abdominal pain, shoulder-tip pain, nausea and vomiting after the surgery, and the mean of liver function tests were evaluated. Data were analyzed using T test, Chi-square test, and repeated measures ANOVA by SPSS 16. Information of 60 patients in two groups was analyzed. There was a significant difference between the groups regarding the mean of systolic blood pressure (P<0.05). The mean of heart rate was significantly higher in the high-pressure group during surgery and 1h after that (P<0.05). The frequency of pain in shoulder-tip and abdomen was higher in the high-pressure group. Frequency of nausea and vomiting 12h after the surgery between two groups was significant (P<0.05). The mean of alkaline phosphatase was higher in the low-pressure group than the high-pressure group (P<0.05). Considering the good performance and low side effects of low-pressure laparoscopic cholecystectomy compared to those of high-pressure, this method can be replaced by high-pressure in LC.

Surgical Space Conditions During Low-Pressure Laparoscopic Cholecystectomy with Deep Versus Moderate Neuromuscular Blockade

Surgical Space Conditions During Low-Pressure Laparoscopic Cholecystectomy with Deep Versus Moderate Neuromuscular Blockade

Impact of low pressure laparoscopic cholecystectomy on hepatic functions

Impact of low pressure laparoscopic cholecystectomy on hepatic functions

Surgical space conditions during low pressure laparoscopic cholecystectomy with deep versus moderate neuromuscular blockade

Surgical space conditions during low pressure laparoscopic cholecystectomy with deep versus moderate neuromuscular blockade

Effects of Varying Intraperitoneal Pressure on Liver Function Tests During Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy at standard-pressure pneumoperitoneum uses a pressure of 12-14 mm Hg, which may cause a variety of adverse physiological changes involving the respiratory, cardiovascular, and hepatorenal systems reflected as subclinical abnormalities in biochemical parameters. The use of low-pressure pneumoperitoneum in the range of 8-10 mm Hg has been shown to reduce the adverse physiological changes without affecting the outcome of surgery. This study was done in a randomized controlled manner. Patients with gallstone disease (n=101) underwent laparoscopic cholecystectomy. Patients were randomly assigned to high-pressure laparoscopic cholecystectomy (HPLC) (n=51) and low-pressure laparoscopic cholecystectomy (LPLC) (n=50) and underwent surgery at pressures of 14 mm Hg and 8 mm Hg, respectively. Liver function tests, including total bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase, were obtained preoperatively and on postoperative Days 1 and 7. The two study groups had similar demographic profiles, and there were no significant differences in the operative time (HPLC, 47.25 ± 6.73 minutes; LPLC, 48.00 ± 7.76 minutes; P=.6071) and pneumoperitoneum time (HPLC, 34.02 ± 5.29 minutes; LPLC, 34.60 ± 6.13 minutes; P=.6115). On postoperative Day 1, the total bilirubin levels were 1.0684 ± 0.4108 mg/dL and 0.8926 ± 0.3162 mg/dL for HPLC and LPLC (P=.0179), respectively, AST levels were 66.0810 ± 25.5868 IU/L and 42.2420 ± 14.7301 IU/L (P=.0001), respectively, and ALT levels were 68.1410 ± 31.4572 IU/L and 42.7460 ± 17.9405 IU/L (P=.0001), respectively. Thus, liver enzyme activities were significantly elevated in the HPLC group compared with the LPLC group. LPLC causes less abnormality in liver function tests in the postoperative period compared with HPLC. LPLC should be considered in all patients undergoing laparoscopic cholecystectomy, especially those patients with compromised liver functions.

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

The increase in intra-abdominal pressure by insufflation of carbon dioxide during laparoscopy brings certain changes in function of organ systems and also leads to postoperative pain. Degree of intra-abdominal pressure is directly related with such change. Laparoscopic cholecystectomy can be performed at low pressure pneumoperitoneum. However, available space for dissection is less than the high pressure pneumoperitoneum. Twenty-six patients for elective laparoscopic cholecystectomy were studied in a prospective, randomized, patient, and surgeon blinded manner. The intra-abdominal pressure was kept either in low pressure (8 mm Hg) or in high pressure (12 mm Hg). All patients underwent two dimensional echocardiography, pulmonary function test and color Doppler examination of lower limb vessels preoperatively and postoperatively. Arterial blood gas analysis and End Tidal CO2 monitored before insufflation, during surgery and after deflation. Pain score was measured by visual analog scale and surgeon's comfort level was recorded. Postoperative analgesia requirement, complications, and hospital stay were recorded. Student t test used for the statistical analysis. Both groups match for the demographic parameters. Four patients required conversion to high pressure. Intraoperative pO2 level, postoperative pain, analgesic requirement, pulmonary function, and hospital stay were favoring low pressure pneumoperitoneum in a statistically significant manner. There was no difference between 2 groups for duration of surgery, intraoperative, and postoperative complications. However, the technical difficulties were graded more (statistically nonsignificant) with low pressure pneumoperitoneum. 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.

Postoperative changes in liver function tests: randomized comparison of low- and high-pressure laparoscopiccholecystectomy

Pneumporeitoneum at 14 mmHg causes dangerous hemodynamic disturbances in some patients, leading to splanchnic ischemia. Laparoscopic cholecystectomy (LC) using low-pressure pneumoperitoneum (7 mmHg) minimizes adverse hemodynamic effects on hepatic portal blood flow and hepatic function. This study evaluated the changes in liver function tests after high-pressure LC (HPLC; 14 mmHg) and low-pressure LC (LPLC; 7 mmHg). For this study, 50 patients were randomly assigned to undergo either HPLC (n = 25) or LPLC (n = 25) Liver function tests including total bilirubin, gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were obtained preoperatively, then 24 and 48 h postoperatively. All patients had normal values on the preoperative liver function tests. The anesthesiologic protocol was uniform. The findings showed that ALT after 24 h (LPLC: 1473.72 +/- 654.85; HPLC: 2233.74 +/- 1247.33; p = 0.0096) and 48 h (LPLC: 1322.99 +/- 601.51; HPLC 2007.80 +/- 747.55; p = 0.0008) and AST after 24 h (LPLC: 1189.96 +/- 404.79 i.j.; HPLC: 1679.40 +/- 766.13; p = 0.0069) were increased in the patients who underwent HPLC. The AST levels after 48 h were statistically unchanged from baseline in both groups. Total bilirubin, ALP, and GGT levels remained unchanged from baseline in both groups, without a significant difference between the two groups. Because LPLC minimizes adverse hemodynamic effects on hepatic function, a low-pressure pneumoperitoneum should be considered for patients with compromised liver function, particularly those undergoing prolonged laparoscopic surgery.