Low-Pressure Versus Standard-Pressure Pneumoperitoneum in Gynecologic Laparoscopic Surgery: A Systematic Review and...

Area of Science:

• Gynecologic Surgery
• Minimally Invasive Procedures
• Anesthesiology

Background:

• Standard-pressure pneumoperitoneum (12-15 mmHg) is common in gynecologic laparoscopy.
• Low-pressure pneumoperitoneum (8-10 mmHg) may reduce postoperative pain and improve outcomes.
• Evidence comparing these pressures is limited.

Purpose of the Study:

• To compare low-pressure (8-10 mmHg) versus standard-pressure (12-15 mmHg) pneumoperitoneum in gynecologic laparoscopic surgery.
• To evaluate effects on postoperative pain, operative time, blood loss, and hospital stay.

Main Methods:

• Systematic search of PubMed, Embase, and Cochrane Central Register.
• Inclusion of randomized controlled trials (RCTs) in adult women undergoing gynecologic laparoscopy.
• Bayesian random-effects meta-analysis of 11 RCTs (1,156 patients).

Main Results:

• Low-pressure pneumoperitoneum showed no significant difference in overall postoperative pain, operative time, blood loss, or hospital stay.
• Subgroup analysis indicated potential pain reduction at 3-6 hours (vs. 15 mmHg) and 24 hours (12 mmHg vs. 15 mmHg).
• Certainty of evidence was rated as very low to moderate.

Conclusions:

• Low-pressure pneumoperitoneum did not consistently improve perioperative outcomes in gynecologic laparoscopy.
• Clinical heterogeneity and low-certainty evidence limit interpretation.
• Further high-quality RCTs are needed to clarify benefits in specific settings or patient groups.