Original Article
Low vs Standard Pneumoperitoneum Pressure During Laparoscopic Hysterectomy: Prospective Randomized Trial

https://doi.org/10.1016/j.jmig.2013.12.091Get rights and content

Abstract

Study Objective

To compare the use of low pneumoperitoneum pressure (LPP; 8 mm Hg) vs standard pneumoperitoneum pressure (SPP; 12 mm Hg) during mini-laparoscopic hysterectomy (MLH).

Design

Randomized controlled trial (Canadian Task Force classification I).

Setting

Tertiary care center.

Patients

Forty-two consecutive women scheduled to undergo MLH to treat benign uterine disease.

Interventions

Women were randomly selected to undergo MLH using LPP (n = 20) or SPP (n = 22). MLH was performed via 3-mm ancillary ports.

Measurements and Main Results

The primary outcome was to evaluate changes in abdominal and shoulder-tip pain via a 100-mm visual analog scale at 1, 3, and 24 hours postoperatively. All procedures were completed via mini-laparoscopy without the need to increase intra-abdominal pressure or convert to conventional laparoscopy or open surgery. Intraoperatively, 1 episode of severe bradycardia occurred in the LPP group, whereas no intraoperative complications were recorded in the SPP group (p = .47). No postoperative complications were recorded (p > .99). Abdominal pain was similar between groups at each time point. Incidence and intensity of shoulder-tip pain at 1 and 3 hours postoperatively was lower in the LPP group than in the SPP group (p < .05), whereas no between-group differences were observed at 24 hours (p > .05). Rescue analgesic requirement did not differ statistically between the LPP and SPP groups (20% vs 41%, respectively; p = .19; odds ratio, 2.7; 95% confidence interval, 0.69–11.08).

Conclusion

In experienced hands, use of LPP is safe and feasible. During performance of MLH, compared with SPP, LPP is a simple method that offers advantages of less shoulder-tip pain.

Section snippets

Materials and Methods

The study was performed at the Department of Obstetrics and Gynaecology of the University of Insubria (Varese, Italy) between June 4 and August 23, 2013. Approval of the Azienda Ospedaliero, Universitaria Ospedale di Circolo, Macchi Foundation, Ethics Committee was obtained, and all patients gave consent for the procedure and for use of their personal information for health research. Patients scheduled to undergo MLH were invited to participate in the study. Inclusion criteria were age

Results

Forty-five patients were included in the study. MLH was performed using LPP in 22 patients (49%), and LPP in 23 (51%). Three patients (7%) who were lost to follow-up were excluded from the analysis, leaving 20 (48%) and 22 (52%) patients in the LPP and SPP groups, respectively. There were no significant differences in demographic characteristics between groups (Table 1). The primary surgical indication was uterine myomas, accounting overall for 81% of all indications, followed by endometrial

Discussion

In the present study we analyzed how the use of different intra-abdominal pressure influences surgical-related outcomes in patients undergoing MLH, and demonstrated a number of noteworthy findings, as follows. LPP is safe and applicable during performance of MLH. Compared with SPP, use of LPP reduces both the incidence and severity of shoulder-tip pain. LPP is related to a 2-fold reduction in the need for postoperative analgesic rescue. Overall, patients undergoing MLH experience low pain

References (29)

  • Ridgeway B, Falcone T. Innovations in minimally invasive hysterectomy. Clin Obstet Gynecol. October 18, 2013 [Epub...
  • M. Frumovitz et al.

    Minimally invasive surgical approaches for patients with endometrial cancer

    Clin Obstet Gynecol

    (2011)
  • F. Ghezzi et al.

    Nerve-sparing minilaparoscopic versus conventional laparoscopic radical hysterectomy plus systematic pelvic lymphadenectomy in cervical cancer patients

    Surg Innov

    (2013)
  • Ghezzi F, Uccella S, Casarin J, Cromi A. Microlaparoscopic bilateral adnexectomy: a 3-mm umbilical port and a pair of...
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    The authors declare no conflicts of interest.

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