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Published on: June 25, 2013
Low-Pressure Versus Standard-Pressure Pneumoperitoneum in Gynecologic Laparoscopic Surgery: A Systematic Review and
Maria Julia Lemos1, Berenice Curi-Pesantes2, Davi Barbosa3
1Department of Women's Health, Kurah Women's Health Institute, Macaé, RJ, Brazil.
Objective:
To compare low-pressure pneumoperitoneum (8-10 mm Hg) with standard-pressure pneumoperitoneum (12-15 mm Hg) in women undergoing gynecologic laparoscopic surgery, focusing on postoperative pain, operative time, estimated blood loss, and length of hospital stay.
Data Sources:
PubMed, Embase, and Cochrane Central Register were systematically searched up to February 2026 using the terms "gynecologic laparoscopy," "pneumoperitoneum," "intraperitoneal pressure," and "insufflation pressure." Reference lists of included studies and prior systematic reviews were also manually searched.
Methods Of Study Selection:
Randomized controlled trials (RCTs) enrolling adult women undergoing gynecologic laparoscopic procedures that compared low- versus standard-pressure pneumoperitoneum and reported at least one outcome of interest were included.
Tabulation Integration And Results:
Eleven RCTs comprising 1156 patients were included. A Bayesian random-effects meta-analysis was performed. Low-pressure pneumoperitoneum was not associated with significant differences in postoperative pain at 24 hours (SMD -0.17; 95% CrI: -0.67, 0.34), postoperative pain at 3-6 hours (SMD -0.45; 95% CrI: -1.34, 0.45), shoulder-tip pain at 24 hours (MD -0.37; 95% CrI: -1.20, 0.43), operative time (MD -0.18 min; 95% CrI: -10.81, 11.14), length of hospital stay (MD -0.03 days; 95% CrI: -0.48, 0.42), or estimated blood loss (MD 31.90 mL; 95% CrI: -4.71, 67.66). Subgroup analysis revealed that low pressure was associated with reduced pain at 3-6 hours compared with 15 mm Hg specifically (MD -0.95; 95% CrI: -1.83, -0.05), and 12 mm Hg was associated with lower pain at 24 hours than 15 mm Hg (MD -0.84; 95% CrI: -1.54, -0.15). The overall certainty of evidence was rated as very low to moderate per GRADE assessment.
Conclusion:
Low-pressure pneumoperitoneum was not associated with consistent improvements in perioperative outcomes compared with standard-pressure pneumoperitoneum in gynecologic laparoscopic surgery. However, clinical heterogeneity, a very low to moderate certainty of evidence, and limited reporting of intraoperative complications, operative conditions, and surgeon satisfaction limit the interpretation and clinical applicability of these findings. Further well-designed RCTs with standardized outcome reporting are needed to determine whether specific surgical settings or patient subgroups may benefit from lower insufflation pressures.
