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Abdominal lift for laparoscopic cholecystectomy
K S Gurusamy1, K Samraj, B R Davidson
1Royal Free and University College School of Medicine, University Department of Surgery, 9th Floor, Royal Free Hospital, Pond Street, London, UK, NW3 2QG. kurinchi2k@hotmail.com
The Cochrane Database of Systematic Reviews
|April 22, 2008
Summary
Abdominal wall lift reduces cardiopulmonary changes during laparoscopic cholecystectomy but does not improve patient outcomes. This technique may increase operating time and costs, so it is not routinely recommended.
Area of Science:
- Minimally Invasive Surgery
- Surgical Techniques
- Cardiopulmonary Physiology
Background:
- Laparoscopic cholecystectomy is standard for symptomatic gallstones.
- Pneumoperitoneum causes cardiopulmonary changes (decreased cardiac output, compliance; increased airway pressure).
- These changes can be problematic for patients with limited cardiopulmonary reserve.
Purpose of the Study:
- To compare abdominal wall lift (AWL) versus pneumoperitoneum for laparoscopic cholecystectomy.
- To assess benefits and harms of AWL in this context.
Main Methods:
- Systematic review of randomized clinical trials (RCTs) up to January 2007.
- Searched multiple databases including Cochrane, MEDLINE, EMBASE.
- Included RCTs comparing AWL (with or without pneumoperitoneum) against pneumoperitoneum.
Main Results:
- AWL (with or without pneumoperitoneum) showed reduced cardiopulmonary changes compared to pneumoperitoneum alone.
- No significant differences in morbidity or pain were observed between groups.
- Operating time was longer with AWL (WMD 7.74, 95% CI 1.37 to 14.12).
Conclusions:
- AWL appears safe and mitigates cardiopulmonary changes during laparoscopic cholecystectomy.
- AWL offers no clear advantage in patient-oriented outcomes for low-risk patients.
- Increased operating time and potential costs mean AWL cannot be routinely recommended; further research is needed.
