Journal of the Chinese Medical Association
Volume 70, Issue 8 , Pages 324-330, August 2007

Randomized Trial of Low-pressure Carbon Dioxide-elicited Pneumoperitoneum Versus Abdominal Wall Lifting for Laparoscopic Cholecystectomy

  • Yih-Huei Uen

      Affiliations

    • Division of General Surgery, Department of Surgery, and Chi Mei Foundation Medical Center, Tainan
    • Taipei Medical University, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Southern Taiwan University of Technology, Tainan, and Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Yi Chen

      Affiliations

    • Division of General Surgery, Department of Surgery, and Chi Mei Foundation Medical Center, Tainan
    • ,
  • Chen-Yi Kuo

      Affiliations

    • Division of General Surgery, Department of Surgery, and Chi Mei Foundation Medical Center, Tainan
    • ,
  • Kuo-Chang Wen

      Affiliations

    • Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Lok-Beng Koay

      Affiliations

    • Department of Internal Medicine, Chi Mei Foundation Medical Center, Tainan
    • Corresponding Author InformationCorrespondence to: Dr Lok-Beng Koay, No. 41, Alley 2, Lane 84, Section 3, Linsen Road, North District, Tainan 704, Taiwan, R.O.C.

Received 20 December 2006; accepted 9 July 2007.

Article Outline

Background

Two alternative surgical techniques for elective laparoscopic cholecystectomy (LC), low-pressure insufflation of the peritoneal cavity and abdominal wall lifting (AWL), have been developed over time to minimize the disadvantages associated with CO2-elicited pneumoperitoneum. To the best of our knowledge, the 2 methods have seldom been compared as regards their relative advantages and disadvantages.

Methods

Eighty patients scheduled for elective LC were randomized into either a low-pressure (8 mmHg) CO2 insufflation method (LPLC) group, or a gasless technique using a subcutaneous abdominal wall lifting device (GLC group). The duration of the surgical procedure, the surgical results including level of postoperative pain, and perioperative cardiopulmonary function changes experienced by the members of both groups were compared.

Results

Laparoscopic surgery was completed for all but 1 patient from each group due to an inadequate surgical-site exposure. There was no mortality for study participants, and no major complications were noted for members of either group. The LPLC group evidenced a shorter surgical duration as compared to the GLC group (77 ± 28 minutes vs. 98 ± 27 minutes, respectively; p < 0.01) and a lower incidence of postoperative shoulder pain (2/38 vs. 8/39, respectively; p < 0.05), although significant differences in intraoperative pulmonary function were noted (an increased PaCO2, PetCO2 and peak-airway pressure and decreased arterial blood pH; p < 0.01) for the LPLC group compared to the GLC group.

Conclusion

Both alternative methods for this type of surgery appeared feasible and safe for LC. Low-pressure CO2 pneumoperitoneum had a shorter surgical duration and less postoperative shoulder pain compared to the GLC technique, but did not feature any other advantage over the AWL technique with regard to impact on cardiopulmonary function.

Key words:  abdominal wall lifting , laparoscopic cholecystectomy , low-pressure pneumoperitoneum

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PII: S1726-4901(08)70013-3

doi:10.1016/S1726-4901(08)70013-3

Journal of the Chinese Medical Association
Volume 70, Issue 8 , Pages 324-330, August 2007

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