Standard vs lower pressure pneumoperitoneum in laparoscopic gynecologic surgery: a randomized controlled trial.
Rebecca Schneyer, Raanan Meyer, Ogechukwu Ezike et al.
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In 30 seconds
This randomized controlled trial compared pneumoperitoneum pressures of 10, 12, and 15 mmHg in 147 patients undergoing conventional laparoscopic gynecologic surgery at a US academic hospital. Maximum postanesthesia care unit pain scores did not differ between groups: median 6.0 in each group (P=.59), and opioid use and other secondary outcomes were also similar. Surgeons rated visualization adequate in 83.3% of cases at 10 mmHg, 97.9% at 12 mmHg, and 100% at 15 mmHg (P<.001). Pressure increases for suboptimal visualization occurred only in the 10-mmHg group.
Key findings
- Maximum recovery-unit pain scores were median 6.0 at 10, 12, and 15 mmHg (P=.59).
- Adequate visualization was reported in 83.3%, 97.9%, and 100% of cases at 10, 12, and 15 mmHg, respectively (P<.001).
- Insufflation pressure was increased for suboptimal visualization in 6 cases, all assigned to 10 mmHg; it was decreased in 3 cases.
- Opioid use and other reported secondary outcomes did not differ between pressure groups.
Why it matters
The trial does not support an expectation that routinely lowering insufflation pressure will reduce immediate postoperative pain or opioid requirements in this surgical population. Visualization was less often rated adequate at 10 mmHg than at higher pressures, although it was still adequate in most cases. These findings help frame the trade-off between pressure and operative conditions in laparoscopic gynecologic surgery.
What to keep in mind
The study was conducted in one academic-hospital practice, and the authors note that findings may be most applicable to similar populations undergoing complex benign gynecologic procedures.