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British Journal of Anaesthesia, Vol 75, Issue 5 567-572, Copyright © 1995 by The Board of Management and Trustees of the British Journal of Anaesthesia

CLINICAL INVESTIGATIONS

Conventional pneumoperitoneum compared with abdominal wall lift for laparoscopic cholecystectomy

L. Lindgren, A. M. Koivusalo and I. Kellokumpu
Department of Anaesthesia, IV Department of Surgery, Helsinki University Hospital, Kasarmikatu 11-13,FIN-00130 Helsinki, Finland; Department of Surgery, IV Department of Surgery, Helsinki University Hospital, Kasarmikatu 11-13,FIN-00130 Helsinki, Finland

We have compared, in a randomized study, conventional carbon dioxide pneumoperitoneum with abdominal wall lift in 25 patients undergoing laparoscopic cholecystectomy. Intra-abdominal pressure (IAP) (11 (SD 2) mm Hg vs 2.7 (9) mm Hg) (P < 0.01) and total amount of carbon dioxide used (40 (23) litre vs 9 (7) litre) (P < 0.001) were significantly less with abdominal wall lift. Pulmonary compliance was significantly greater (P < 0.01) in the abdominal wall lift group throughout operation. During the first 15 min of insufflation, arterial pressures were lower with abdominal wall lift (P < 0.05). In the conventional pneumoperitoneum group, femoral vein pressure increased (P < 0.01) and remained elevated for 3 h in the recovery room. Postoperative drowsiness was of significantly longer duration in the conventional pneumoperitoneum group than in the abdominal wall lift group (98 (46) min vs 13 (34) min) (P < 0.01). Postoperative nausea and vomiting and right shoulder pain occurred more often in patients with conventional pneumoperitoneum (P < 0.05). We conclude that the benefits of abdominal wall lift may be attributed to avoiding excessive carbon dioxide and high IAP.
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