Abdominal wall lift versus positive-pressure capnoperitoneum for laparoscopic cholecystectomy

Ann Surg. 2004 Mar;239(3):388-94.
Abdominal wall lift versus positive-pressure capnoperitoneum for laparoscopic cholecystectomy: randomized controlled trial.

Alijani A, Hanna GB, Cuschieri A.Department of Surgery and Molecular Oncology, Ninewells Hospital and Medical School, Dundee, Scotland.OBJECTIVE: To compare intraoperative cardiac function, postoperative cognitive recovery, and surgical performance of laparoscopic cholecystectomy with abdominal wall lift (AWL) versus positive-pressure capnoperitoneum (PPCpn).
SUMMARY BACKGROUND DATA: AWL has been proposed as an alternative approach to PPCpn to avoid adverse cardio-respiratory changes. However, the workspace obtained with the AWL is less optimal than PPCpn and previous studies documenting delayed postoperative recovery of consciousness following PPCpn have not assessed mental alertness despite its importance. METHODS: Forty operations were randomized into AWL and PPCpn. A standard anesthetic protocol was followed. Cardiac indices were measured with an esophageal Doppler machine. An auditory vigilance test was used to measure alertness level following extubation. All operations were videotaped and human reliability assessment techniques were used to identify surgical errors. RESULTS: There was a significant reduction in cardiac output during the first 20 minutes following CO2 insufflation in the PPCpn group, whereas in the AWL group it did not exhibit any significant change. Patients in AWL arm had better vigilance scores at 90 and 180 minutes following extubation compared with the PPn group (P < p =" 0.001).">Clinical Trial
Randomized Controlled Trial PMID: 15075657 [PubMed - indexed for MEDLINE]