Comparison between CO2 insufflation and abdominal wall lift in laparoscopic cholecystectomy - A prospective multiinstitutional study in Japan

Background: Abdominal wall lift (AWL,) was developed mainly in Japan to avo id insufflation-related complications and to improve cost performance. AWL, however, has been criticized for its poor Visibility in obese patients, th e complexity of preparing the lifting instruments, and increased inflammato ry reactions. As experience with AWL has increased, proponents of the proce dure have come to believe that AWL is simple enough to qualify as a standar d method of laparoscopic surgery even in obese patients. Postoperatively, i ssues such as pain, changes in body temperature, and time before returning to work do not appear to be much different from those after CO, insufflatio n. Methods: Twenty-three institutions participated in a prospective study to c ompare the effects of insufflation and AWL on surgical performance and post operative course of laparoscopic surgery. Biochemical markers were also inv estigated including inflammatory responses. The patients were allocated to the participants to prevent experience-biases. A total of 144 patients were reviewed. Results: Background factors such as male-female ratio, age and body-mass in dex were similar in each group. The incidence of conversion-to-open was not significantly different between insufflation and AWL. Preparation time and operating time were not significantly different, either. Serum CPK showed a significantly higher value one day after peritoneal lift than after subcu taneous lift. CPK level after insufflation was between that of peritoneal l ift and after subcutaneous lift. Differences in changes of plasma interleuk in 6 and other surgical stress markers were not observed. Conclusions: This prospective study, although not randomized, suggests that , except for invasiveness to the muscular layers of the abdominal wall, the re may be no substantial difference between AWL and insufflation or among s ubcutaneous lift, peritoneal lift or insufflation in terms of morbidity, mo rtality, preparation time, operating time, inflammatory reactions, and post operative clinical course.