.Gurusamy KS, Samraj K, Davidson BR.Published Online: July 16, 2008.Several physiological parameters related to heart and lung (cardiopulmonary changes) occur during insufflation of abdomen (tummy) with key-hole surgery. While these changes can be tolerated by normal individuals, patients with poor heart or lung function may not tolerate the changes. These changes in physiological parameters related to heart and lung are decreased by using special instruments to lift the front wall of the abdomen so that key-hole surgery can be performed without gas insufflation. In this systematic review of 20 trials including 706 patients (six trials including 156 patients used gas at very low pressures), it is shown that the technique of lifting the front wall of the tummy is associated with increased operating time (8 minutes) without reducing surgical complications. It cannot be recommended as a routine in patients with mild or no systemic disease. So, it cannot be recommended routinely in patients with low anaesthetic risk.