Abdominal lift for laparoscopic cholecystectomy

Area of Science:

• Surgical Innovation
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Laparoscopic cholecystectomy is the standard for symptomatic gallstones.
• Pneumoperitoneum, used in laparoscopy, causes cardiopulmonary changes.
• These changes may be poorly tolerated by patients with limited cardiopulmonary reserve.

Purpose of the Study:

• To compare the benefits and harms of abdominal wall lift versus pneumoperitoneum.
• To evaluate outcomes in patients undergoing laparoscopic cholecystectomy.

Main Methods:

• Systematic review of randomized clinical trials.
• Searched Cochrane Hepato-Biliary Group Register, CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded.
• Analyzed data using fixed-effect and random-effects models.

Main Results:

• Abdominal wall lift showed no significant advantage in patient-oriented outcomes compared to pneumoperitoneum.
• Operating time was longer with abdominal wall lift, potentially increasing costs.
• Trials had a high risk of bias, and few patients were included, limiting definitive conclusions.

Conclusions:

• Abdominal wall lift is not recommended routinely for laparoscopic cholecystectomy in low-anesthetic-risk patients.
• Further research, including higher-risk patients and blinded assessments, is needed to establish safety and efficacy.
• The current evidence suggests no clear benefit over standard pneumoperitoneum.