Physiologic stress responses to laparoscopic cholecystectomy

Nanashima, Atsushi; Yamaguchi, Hiroichiro; Tsuji, Takashi; Yamaguchi, Eiichiro; Sawai, Terumitsu; Yasutake, Toru; Nakagoe, Toru; Ayabe, Hiroyoshi

doi:10.1007/s004649900863

Cited by 9 publications

(3 citation statements)

References 29 publications

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“…For all other procedures only a qualitative analysis was performed. Data extracted from all 43 included articles are shown in Table 4 15,16,19,28,29,33,39–74 …”

Section: Resultsmentioning

confidence: 99%

Gasless laparoscopy versus conventional laparoscopy and laparotomy: A systematic review on the safety and efficiency

et al. 2023

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BackgroundGasless laparoscopy (GL) emerged to overcome the clinical and financial challenges of pneumoperitoneum and is often seen as a viable option for use in resource‐limited settings as a means of saving costs and resources. This study aims to systematically review the evidence available on the safety and efficiency of GL compared with conventional laparoscopy (CL) and laparotomy.MethodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, Medline, Embase, Web of Science and Cochrane databases were searched. Variables of interest were determined a priori and Covidence software was used to screen studies for inclusion without demographic preference. The quality of studies was assessed using the Cochrane Risk Assessment tool.ResultsOf the 1080 studies screened, a total of 43 studies were included. Laparoscopic cholecystectomy was by far the most studied intervention in randomised studies. In these, the mean setup time for gasless and CL was 13.14 (95% CI −0.16 to 26.44) and 12.8 (95% CI −10.86 to 36.47) minutes, respectively. The mean duration of surgery for gasless and CL was 89.39 (95% CI 77.44 to 101.34) and 72.59 (95% CI 63.44 to 81.74) minutes, respectively, and the mean length of stay was 4.25 (95% CI 2.02 to 6.48) and 4.04 (95% CI 1.72 to 6.36) days, respectively. Most reported complications were haemorrhage and infection with no assessable statistical difference.ConclusionsAlthough GL seems to be a feasible approach for many general surgery interventions, the observed outcomes based on safety and efficiency are not sufficient to recommend GL as an alternative to CL or laparotomy. Larger randomised trials with a low risk of bias are warranted.

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“…For all other procedures only a qualitative analysis was performed. Data extracted from all 43 included articles are shown in Table 4 15,16,19,28,29,33,39–74 …”

Section: Resultsmentioning

confidence: 99%

Gasless laparoscopy versus conventional laparoscopy and laparotomy: A systematic review on the safety and efficiency

et al. 2023

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“…A detailed summary of the risk of bias for RCTs using RoB-2 tool is listed in Table 3 Supplement. In the non-RCT group, there were 12 general surgery and 10 gynaecology studies, with a total of 1,385 patients (Table 2 Supplement) [14][15][16][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83]. The overall result level assessment for each outcome varied between low to high risk of bias.…”

Section: Resultsmentioning

confidence: 99%

Clinical effectiveness of gasless laparoscopic surgery for abdominal conditions: systematic review and meta-analysis

et al. 2021

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Background In high-income countries, laparoscopic surgery is the preferred approach for many abdominal conditions. Conventional laparoscopy is a complex intervention that is challenging to adopt and implement in low resource settings. This systematic review and meta-analysis evaluate the clinical effectiveness of gasless laparoscopy compared to conventional laparoscopy with CO2 pneumoperitoneum and open surgery for general surgery and gynaecological procedures. Methods A search of the MEDLINE, EMBASE, Global Health, AJOL databases and Cochrane Library was performed from inception to January 2021. All randomised (RCTs) and comparative cohort (non-RCTs) studies comparing gasless laparoscopy with open surgery or conventional laparoscopy were included. The primary outcomes were mortality, conversion rates and intraoperative complications. Secondary outcomes: operative times and length of stay. The inverse variance random-effects model was used to synthesise data. Results 63 studies were included: 41 RCTs and 22 non-RCTs (3,620 patients). No procedure-related deaths were reported in the studies. For gasless vs conventional laparoscopy there was no difference in intraoperative complications for general RR 1.04 [CI 0.45–2.40] or gynaecological surgery RR 0.66 [0.14–3.13]. In the gasless laparoscopy group, the conversion rates for gynaecological surgery were high RR 11.72 [CI 2.26–60.87] when compared to conventional laparoscopy. For gasless vs open surgery, the operative times were longer for gasless surgery in general surgery RCT group MD (mean difference) 10 [CI 0.64, 19.36], but significantly shorter in the gynaecology RCT group MD − 18.74 [CI − 29.23, − 8.26]. For gasless laparoscopy vs open surgery non-RCT, the length of stay was shorter for gasless laparoscopy in general surgery MD − 3.94 [CI − 5.93, − 1.95] and gynaecology MD − 1.75 [CI − 2.64, − 0.86]. Overall GRADE assessment for RCTs and Non-RCTs was very low. Conclusion Gasless laparoscopy has advantages for selective general and gynaecological procedures and may have a vital role to play in low resource settings.

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“…The same clinical design has been used by other authors to evaluate leukocyte count, interleukin-6 levels, arterial blood gases, creatinine clearance, plasma renin activity, cardiothoracic ratio, and clinical outcome. They found no differences between abdominal wall retraction (n ϭ 11) and CO 2 pneumoperitoneum (n ϭ 16) when performing laparoscopic cholecystectomy [19].…”

Section: Discussionmentioning

confidence: 94%

Lactate Metabolism during Laparoscopic Cholecystectomy: Comparison between CO2 Pneumoperitoneum and Abdominal Wall Retraction

et al. 2001

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Recent reports have implicated CO2 pneumoperitoneum for laparoscopic surgery in the occurrence of postoperative mesenteric ischemia. With this kind of surgery, the increase in blood lactate levels has been attributed to anaerobic metabolism, probably due to tissue ischemia induced by high intraabdominal pressure (IAP). The aim of this study was to evaluate the metabolic repercussion of CO2 pneumoperitoneum during laparoscopic cholecystectomy (LC). This was a prospective randomized study of CO2 pneumoperitoneum (PP group, n = 19) versus abdominal wall retraction (AWR group, n = 15). Demographic data were collected preoperatively. Four-trocar LC was performed with either a CO2 pneumoperitoneum (IAP of 12 mmHg) or abdominal wall retraction (abdominal wall pressure 6-10 kp). Intraoperative and postoperative blood samples were collected and lactate levels determined by enzymatic analysis. Repeated measures analysis of variance (MANOVA) was used for statistical analysis. Significance was evaluated at p < 0.05. The groups were shown to be homogeneous. Lactate concentration, expressed as mean (SD), went from 25.4 (14.4) mg/dl at baseline to 18.9 (13.6) mg/dl 4 hours after surgery in the PP group and from 19.4 (6.1) mg/dl at baseline to 17.8 (14.7) mg/dl in the AWR group. No significant differences were found between groups intraoperatively (p = 0.116) or postoperatively (p = 0.99). Our study did not show significant differences in blood lactate levels during LC with CO2 pneumoperitoneum compared to the same procedure with abdominal wall retraction.

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Physiologic stress responses to laparoscopic cholecystectomy

Abstract: Our results indicate that both PP and AWL are appropriate for patients without serious complications.

Cited by 9 publications

References 29 publications

Gasless laparoscopy versus conventional laparoscopy and laparotomy: A systematic review on the safety and efficiency

Gasless laparoscopy versus conventional laparoscopy and laparotomy: A systematic review on the safety and efficiency

Clinical effectiveness of gasless laparoscopic surgery for abdominal conditions: systematic review and meta-analysis

Lactate Metabolism during Laparoscopic Cholecystectomy: Comparison between CO2 Pneumoperitoneum and Abdominal Wall Retraction

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