Standard vs lower pressure pneumoperitoneum in laparoscopic gynecologic surgery: a randomized controlled trial

Area of Science:

• Minimally invasive gynecologic surgery
• Laparoscopic surgical techniques
• Pain management in surgery

Background:

• Postoperative pain following laparoscopic surgery can impede recovery and increase opioid consumption.
• While lower insufflation pressures are known to reduce pain in general surgery, their effect in gynecologic procedures is not well-documented.

Purpose of the Study:

• To evaluate the impact of varying insufflation pressures on postoperative pain and surgical field visualization in patients undergoing laparoscopic gynecologic surgery.
• To compare outcomes between 10 mmHg, 12 mmHg, and 15 mmHg insufflation pressures.

Main Methods:

• A randomized controlled trial involving 147 patients undergoing conventional laparoscopy.
• Patients were assigned to 10 mmHg, 12 mmHg, or 15 mmHg insufflation pressures.
• Primary outcome was maximum post-anesthesia care unit (PACU) pain score; secondary outcomes included visualization, operative time, and opioid use.

Main Results:

• No significant differences in maximum PACU pain scores were observed among the three pressure groups (P = 0.59).
• Surgeon satisfaction with operative field visualization improved with higher pressures (83.3% at 10 mmHg vs. 100% at 15 mmHg; P < 0.001).
• No differences in opioid use or other secondary outcomes were noted.

Conclusions:

• Lower insufflation pressures (10-15 mmHg) did not decrease postoperative pain or opioid requirements in this laparoscopic gynecologic surgery cohort.
• Adequate operative field visualization was maintained, even at 10 mmHg, with improvements at 12 mmHg and 15 mmHg.
• Individualization of insufflation pressure based on patient factors is supported, as intraoperative adjustments were uncommon.