Randomized comparison between low-pressure laparoscopic cholecystectomy and gasless laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy using low-pressure pneumoperitoneu m (8 mmHg) minimizes adverse hemodynamic effects, reduces postoperative pai n, and accelerates recovery. Similar claims are made for gasless laparoscop y using abdominal wall lifting. The aim of this study was to compare gasles s laparoscopic cholecystectomy to low-pressure cholecystectomy with respect to postoperative pain and recovery. Methods: Thirty-six patients were randomized to low-pressure or gasless lap aroscopic cholecystectomy using a subcutaneous lifting system (Laparotenser ). Results: The characteristics of the patients were similar in the two groups . The procedure was completed in all patients in the low-pressure group, bu t two patients in the gasless group were converted to pneumoperitoneum. The re were no significant differences in postoperative pain and analgesic cons umption, but patients in the gasless group developed shoulder pain more fre quently (50% vs 11%, p < 0.05). Gasless operation took longer to perform (9 5 vs 72.5 min, p 0.01). Conclusions: Gasless and low-pressure laparoscopic cholecystectomy were sim ilar with respect to postoperative pain and recovery. The gasless technique provided inferior exposure and the operation took longer, but the techniqu e may still have value in high-risk patients with cardiorespiratory disease .