Comparative analysis of low versus normal pressure pneumoperitoneum in laparoscopic gynecological surgeries: a randomized control trial

BACKGROUND: Laparoscopic gynecological surgeries have evolved in the modern scenario. Pneumoperitoneum is the first crucial step of laparoscopic surgery. 15mmHg pressure has typically been preferred over the years for easier port manipulation, visualization, and tissue dissection, yet it was accompanied by increased shoulder tip pain and laparoscopy-related complications. Low pressure pneumoperitoneum may influence intraoperative and postoperative outcomes and may help reduce postoperative morbidities. There is paucity of research that compare intra and postoperative outcomes from laparoscopic operations with low pressure and normal pressure pneumoperitoneum.METHODS: It is a single-center, double-blinded randomized control trial conducted over 18 months after approval from institutional review board. After eligibility assessment, 40 patients underwent randomization. The analyzer assured the allocation concealment using SNOSE (Sequentially, numbered opaque, sealed envelopes). Patients were allocated into group A: Normal pressure group (12 mmHg) and Group B: low-pressure group (8 mmHg). Patients in both groups underwent total laparoscopic hysterectomies for benign indications. Both groups were compared for postoperative pain using the visual analog score, need for additional analgesia, postoperative ileus, nausea and vomiting, duration of hospital stay, and need for readmission in the next 28 days following surgery. Intraoperative parameters studied included gas consumption, blood loss, time of surgery, need to raise the pressure, and intraoperative adverse events.RESULTS: When compared to normal pressure pneumoperitoneum, low pressure pneumoperitoneum at 8 mm Hg significantly reduces postoperative pain and promotes an early recovery of bowel function. Low-pressure pneumoperitoneum, however, was unable to suppress postoperative nausea and vomiting.CONCLUSIONS: In laparoscopic hysterectomies for benign diseases, low-pressure pneumoperitoneum can be utilized safely to lessen ileus and postoperative discomfort.