Low-pressure pneumoperitoneum versus standard pneumoperitoneum in laparoscopic cholecystectomy, a prospective randomized clinical trial

Sandhu, Trichak; Yamada, Sirikan; Ariyakachon, Veeravorn; Chakrabandhu, Thiraphat; Chongruksut, Wilaiwan; Ko-iam, Wasana

doi:10.1007/s00464-008-0119-2

Cited by 115 publications

(109 citation statements)

References 24 publications

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“…The use of pharmacological agents to achieve deep relaxation throughout the laparoscopic procedure allows the surgeons either to proceed at the same level of CO 2 insufflation while benefitting from better surgical conditions, or lowering the insufflating pressure to lower the risk of surgical complications. Several studies have shown the positive effect of lowering the working pressure 5,6,7 . One symptom that is often seen after laparoscopic hysterectomies is shoulder pain, which is often stated as a major problem and the most important issue when speaking to the patient at follow up.…”

Section: Introductionmentioning

confidence: 99%

Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy

Lindekær

Springborg

Istre

2013

JoVE

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Shoulder pain is a commonly reported symptom following laparoscopic procedures such as myomectomy or hysterectomy, and recent studies have shown that lowering the insufflation pressure during surgery may reduce the risk of post-operative pain. In this pilot study, a method is presented for measuring the intra-abdominal space available to the surgeon during laproscopy, in order to examine whether the relaxation produced by deep neuromuscular blockade can increase the working surgical space sufficiently to permit a reduction in the CO 2 insufflation pressure. Using the laproscopic grasper, the distance from the promontory to the skin is measured at two different insufflation pressures: 8 mm Hg and 12 mm Hg. After the initial measurements, a neuromuscular blocking agent (rocuronium) is administered to the patient and the intraabdominal volume is measured again. Pilot data collected from 15 patients shows that the intra-abdominal space at 8 mm Hg with blockade is comparable to the intra-abdominal space measured at 12 mm Hg without blockade. The impact of neuromuscular blockade was not correlated with patient height, weight, BMI, and age. Thus, using neuromuscular blockade to maintain a steady volume while reducing insufflation pressure may produce improved patient outcomes. Video LinkThe video component of this article can be found at

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Section: Introductionmentioning

confidence: 99%

Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy

Lindekær

Springborg

Istre

2013

JoVE

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“…Various authors have reported that laparoscopic cholecystectomy performed with LPP results in a better postoperative quality of life as compared to laparoscopic cholecystectomy performed with HPP. [16][17][18] In our study contact of parietal peritoneum to the underlying viscera during secondary port insertion under vision after insertion of primary port, was taken as indirect indicator of potential of causing visceral injury at a particular intraabdominal pressure. Out of 180 secondary ports inserted, there was evident contact of 20 (11.1%) secondary ports in high pressure groups and 14 (7.7%) secondary ports in low pressure group, which is suggestive of adequate exposure and working space available for surgery at both pressures.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative safety of low pressure pneumoperitoneum cholecystectomy: a comparative study

Mahajan¹,

Shankar²,

Garg³

et al. 2017

Int Surg J

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Background: With the establishment of laparoscopic cholecystectomy as gold standard for management of cholelithiasis, the current stress is on increasing patient safety. Hence, this study was undertaken to compare the effect of low pressure pneumoperitoneum (LPP <10mm Hg) versus high pressure pneumoperitoneum (HPP >14mm Hg) in a prospective randomized manner on intraoperative safety, assessing the working space and safety by seeing contact of parietal peritoneum to underlying viscera during secondary port insertion.Methods: 120 patients undergoing laparoscopic cholecystectomy were randomized into the LPP (<10mm Hg) group (n=60) and the HPP (>14mm Hg) group (n=60) prospectively. Available working space assessed directly, safety by contact of parietal peritoneum to underlying viscera during secondary port insertion and operative difficulty assessed by visualization, dissection and grasping, total duration of surgery; intra-operative gas consumption, and bile spillage were assessed.Results: There was no significant difference in terms of available working space, operative duration, consumption of carbon dioxide, surgeon’s operative difficulty and intraoperative bile spillage. Out of 180 secondary ports inserted, there was evident contact of 20 (11.1%) secondary ports in high pressure groups and 14 (7.7%) secondary ports in low pressure group, which is suggestive of adequate exposure and working space available for surgery at both pressures.Conclusions: Low-pressure cholecystectomy did not compromise intraoperative safety and should be the standard of care in day care surgery.

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“…En seres humanos y animales, la laparoscopia causa malestar en los pacientes (16,18). El origen del dolor post-laparoscopia en humanos se puede clasificar en tres aspectos: visceral, incisión y dolor en el hombro (este último asociado posiblemente a la sobredistensión de las fibras musculares del diafragma) (18).…”

Section: Discussionunclassified

“…El origen del dolor post-laparoscopia en humanos se puede clasificar en tres aspectos: visceral, incisión y dolor en el hombro (este último asociado posiblemente a la sobredistensión de las fibras musculares del diafragma) (18). Los trabajos realizados en caninos, demuestran la reducción en el dolor comparado con las técnicas abiertas; sin embargo no se conocen trabajos que identifiquen dolor visceral o de otro tipo asociado al pneumoperitoneo.…”

Section: Discussionunclassified

Criptorquidectomía laparoscópica en dos perros utilizando bisturí ultrasónico

2013

Rev MVZ Córdoba

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RESUMENTradicionalmente, los perros con testículos retenidos abdominales son remitidos para orquiectomía a través de laparotomía media ventral o paraprepucial. Sin embargo, las técnicas mínimamente invasivas realizadas a través de equipos endoscópicos, son una alternativa excelente para efectuar el procedimiento, debido a las ventajas en la reducción del trauma tisular y un menor dolor posoperatorio, además de la reducción de complicaciones posquirúrgicas entre otras ventajas. A continuación se presentan dos casos de pacientes caninos criptórquidos intervenidos quirúrgicamente mediante laparoscopia, para la extracción de los testículos retenidos en las que además se utilizó un bisturí ultrasónico. En Colombia, el desarrollo de las técnicas endoscópicas en cirugía de pequeños animales aún se encuentra muy limitado, y probablemente esta sea la primera publicación en el país acerca del uso de laparoscopia en casos de orquiectomía en pacientes con testículos retenidos en la cavidad abdominal.Palabras clave: Criptorquidismo, laparoscopia, perro (Fuente: CAB). ABSTRACTTraditionally, dogs with abdominally retained testicles are submitted to orchiectomy throughout a ventral midline or parapreputial laparotomy. However, minimally invasive techniques performed using endoscopic equipment are an excellent alternative for the abdominal procedure, because of the advantages in tissular trauma reduction, less postoperative pain and reduction in complications among other advantages. Two cases of abdominal cryptorchidectomy performed using minimally invasive techniques and ultrasonic scalpel in dogs, are presented in this report. In Colombia, the development of minimally invasive techniques in small animal surgery is still very limited, and this is possibly the first publication in the country regarding the use of this technique in two cases of abdominal cryptorchidism in dogs.

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Low-pressure pneumoperitoneum versus standard pneumoperitoneum in laparoscopic cholecystectomy, a prospective randomized clinical trial

Abstract: Low-pressure pneumoperitoneum tended to be better than standard-pressure pneumoperitoneum in terms of lower incidence of shoulder tip pain, but this difference did not reach statistical significance following elective laparoscopic cholecystectomy.

Cited by 115 publications

References 24 publications

Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy

Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy

Intraoperative safety of low pressure pneumoperitoneum cholecystectomy: a comparative study

Criptorquidectomía laparoscópica en dos perros utilizando bisturí ultrasónico

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