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Abdominal lift for laparoscopic cholecystectomy
Kurinchi Selvan Gurusamy1, Rahul Koti, Brian R Davidson
1Department of Surgery, Royal Free Campus, UCL Medical School, Royal Free Hospital,, Rowland Hill Street, London, UK, NW3 2PF.
The Cochrane Database of Systematic Reviews
|September 3, 2013
Summary
Abdominal wall lift offers no clear benefit over standard pneumoperitoneum for laparoscopic cholecystectomy in low-risk patients. Further research is needed to establish safety and efficacy in broader patient populations.
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 abdominal wall lift as an alternative to pneumoperitoneum in laparoscopic cholecystectomy.
Main Methods:
- Systematic review and meta-analysis of randomized clinical trials.
- Searched Cochrane Hepato-Biliary Group Trials Register, CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded.
- Included trials comparing abdominal wall lift (with or without pneumoperitoneum) versus pneumoperitoneum.
Main Results:
- Abdominal wall lift showed no significant difference in serious adverse events or mortality compared to pneumoperitoneum.
- Operating time was longer with abdominal wall lift (with or without pneumoperitoneum) compared to pneumoperitoneum alone.
- Data on quality of life, pain, and day-patient discharge rates were not reported in most trials.
Conclusions:
- Abdominal wall lift does not offer apparent advantages for patient-oriented outcomes in laparoscopic cholecystectomy for low-risk individuals.
- Routine recommendation of abdominal wall lift is not supported by current evidence.
- Further high-quality research, including patients with higher anesthetic risk and blinded outcome assessment, is necessary.