Randomized comparison between low-pressure laparoscopic cholecystectomy and gasless laparoscopic cholecystectomy

Area of Science:

• Minimally invasive surgery
• Surgical techniques
• Gastrointestinal surgery

Background:

• Low-pressure pneumoperitoneum (8 mmHg) in laparoscopic cholecystectomy offers hemodynamic benefits, reduced pain, and faster recovery.
• Gasless laparoscopy, utilizing abdominal wall lifting, is also claimed to provide similar advantages.
• A comparative study is needed to evaluate these claims.

Purpose of the Study:

• To compare gasless laparoscopic cholecystectomy with low-pressure pneumoperitoneum laparoscopic cholecystectomy.
• To assess differences in postoperative pain and patient recovery between the two techniques.

Main Methods:

• Thirty-six patients undergoing cholecystectomy were randomized into two groups: low-pressure pneumoperitoneum or gasless laparoscopy.
• Gasless laparoscopy employed a subcutaneous lifting system (Laparotenser).

Main Results:

• No significant differences were observed in postoperative pain or analgesic consumption between the groups.
• Patients undergoing gasless laparoscopy experienced more frequent shoulder pain (50% vs. 11%).
• Gasless procedures were longer (95 min vs. 72.5 min) and had a higher conversion rate to pneumoperitoneum.

Conclusions:

• Both gasless and low-pressure laparoscopic cholecystectomy offer comparable postoperative pain and recovery outcomes.
• Gasless laparoscopy presents challenges with exposure and increased operative time.
• The gasless technique may be beneficial for high-risk patients with cardiorespiratory conditions.