The usefulness of low-pressure pneumoperitoneum in laparoscopic surgery.

The aim of the study was to assess the usefulness of low-pressure pneumoperitoneum (LP) in laparoscopic surgery. A consecutive group of 152 patients qualified for laparoscopic cholecystectomy (LC) was assessed as to the possibility of performing the procedure with LP 7 mmHg. The following exclusion criteria were used: Body Mass Index (BMI) > 27 and laparotomy in medical history. The subsequent stage of the trial included 82 (53.9%) patients (73 females, 9 males) meeting the inclusion criteria. The mean BMI was 25.23 +/- 1.4; mean age was 46 +/- 7.8 years. All the patients suffered from symptomatic uncomplicated gallstones confirmed in ultrasound. The pneumoperitoneum was created in a blind way with a Veress needle up to pressure of 12 mmHg and the first 10 mm TERNAMIAN-EndoTip trocar was introduced under direct visual control. After the placement of other trocars, the working pressure was reduced from 12 mmHg to 7 mmHg. The pCO2 concentration was monitored intraoperatively by a capnometer. Among 82 patients included into the study the LPLC was successfully performed in 73 (89%) patients. In 8 (9.75%) patients the working pressure had to be increased to 15 mm Hg due to the gallbladder exceeding 12 cm in length and difficulties in its proper mobilization required to visualize the neck of the gallbladder. All these patients were male and 3 of them were 55 years of age or more. In 1 (1.22%) patient conversion was necessary because of difficulties in identification of anatomical structures within the Calot's triangle. LC can be performed with a use of the LP technique in the majority of patients with BMI < 27 and no previous history of laparotomy. Gallbladder assessed in preoperative ultrasound as longer than 12 cm as well as male sex and age over 55 years indicate a higher risk of failure of the 4-trocar LPLC technique.