Low vs Standard Pressures in Gynecologic Laparoscopy: a Systematic Review

Area of Science:

• Minimally Invasive Surgery
• Gynecologic Surgery
• Anesthesiology

Background:

• Optimal intraperitoneal pressure during laparoscopy remains undetermined.
• Emerging literature suggests benefits of lower pressures, necessitating safety evaluations.
• This review systematically compares low versus standard pneumoperitoneum in gynecologic laparoscopy.

Purpose of the Study:

• To compare the effects of low versus standard intraperitoneal pressure during gynecologic laparoscopy.
• To assess the safety and efficacy of reduced pneumoperitoneum in this surgical context.

Main Methods:

• Systematic review of randomized controlled trials sourced from Medline, Embase, and Cochrane Library.
• Data extraction and analysis by two independent reviewers using RevMan5.
• Included three trials with a total of 238 patients.

Main Results:

• A modest reduction in postoperative pain was observed with low pressure (8 mm Hg vs. ≥ 12 mm Hg).
• Significantly worse visualization of the surgical field was associated with lower intraperitoneal pressures (RR, 10.31).
• No significant differences were found in blood loss, surgical duration, hospital stay, or need for increased pressure.

Conclusions:

• Low intraperitoneal pressure is not recommended for gynecologic laparoscopy due to minimal pain improvement and compromised visualization.
• Further studies are required to evaluate the safety and cost-effectiveness of this intervention.