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Low Pneumoperitoneum Pressure Reduces Pain After Mini-Laparoscopic Hysterectomy: Results From Two Independent Randomized Controlled Trails

2014; Elsevier BV; Volume: 21; Issue: 5 Linguagem: Inglês

10.1016/j.jmig.2014.02.010

1553-4669

Giorgio Bogani, Antonella Cromi, Jvan Casarin, Fabio Ghezzi,

Appendicitis Diagnosis and Management

Since the introduction of laparoscopic hysterectomy, its role has continued to increase [ 1 Falcone T. What is new in minimally invasive surgery? best articles from the past year. Obstet Gynecol. 2012; 120: 952-953 Crossref PubMed Scopus (1) Google Scholar ]. Although active attempts, including reduction of the number and size of ancillary ports, have been investigated to minimize postoperative pain, only a few studies have evaluated the role of pneumoperitoneum in the genesis of postoperative pain [ 2 Fanfani F. Fagotti A. Gagliardi M.L. et al. Minilaparoscopic versus single-port total hysterectomy: a randomized trial. J Minim Invasive Gynecol. 2013; 20: 192-197 Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar , 3 Ghezzi F. Cromi A. Siesto G. et al. Minilaparoscopic versus conventional laparoscopic hysterectomy: results of a randomized trial. J Minim Invasive Gynecol. 2011; 18: 455-461 Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar , 4 Bogani G. Uccella S. Cromi A. et al. Low vs. standard pneumoperitoneum pressure during laparoscopic hysterectomy: a prospective randomized trial. J Minim Invasive Gynecol. 2013; ([Epub ahead of print])https://doi.org/10.1016/j.jmig.2013.12.091 Abstract Full Text Full Text PDF Scopus (52) Google Scholar , 5 Tsai H.W. Wang P.H. Yen M.S. Chao K.C. Hsu T.F. Chen Y.J. Prevention of postlaparoscopic shoulder and upper abdominal pain: a randomized controlled trial. Obstet Gynecol. 2013; 121: 526-531 Crossref PubMed Scopus (46) Google Scholar ]. Recently, our study group investigated how various degrees of intra-abdominal pressure (IAP) influence postoperative pain in patients undergoing mini-laparoscopic hysterectomy [ 4 Bogani G. Uccella S. Cromi A. et al. Low vs. standard pneumoperitoneum pressure during laparoscopic hysterectomy: a prospective randomized trial. J Minim Invasive Gynecol. 2013; ([Epub ahead of print])https://doi.org/10.1016/j.jmig.2013.12.091 Abstract Full Text Full Text PDF Scopus (52) Google Scholar ]. We observed that low pneumoperitoneum pressure (LPP; 8 mm Hg) is associated with less shoulder tip pain when compared with standard pneumoperitoneum pressure (SPP; 12 mm Hg). In particular, we observed that both incidence and intensity of shoulder tip pain are reduced in patients undergoing surgery using LPP compared with SPP, whereas no between-group differences in abdominal pain were recorded [ 4 Bogani G. Uccella S. Cromi A. et al. Low vs. standard pneumoperitoneum pressure during laparoscopic hysterectomy: a prospective randomized trial. J Minim Invasive Gynecol. 2013; ([Epub ahead of print])https://doi.org/10.1016/j.jmig.2013.12.091 Abstract Full Text Full Text PDF Scopus (52) Google Scholar ]. Minimally Invasive Insufflation Technique Is and Should Not Be a "Black Box" PrincipleJournal of Minimally Invasive GynecologyVol. 21Issue 6PreviewWe read with great interest both recent articles by Bogani et al [1,2]. We congratulate the authors on their studies and support their statement that low-pressure pneumoperitoneum is feasible and safe for performance of laparoscopic hysterectomy and might even reduce pain. Full-Text PDF