Randomized Controlled Trial of Conventional Carbon Dioxide Pneumoperitoneum versus Gasless Technique for Laparoscopic Cholecystectomy

摘要

Concerns about pathophysiologic changes and disadvantages associated with carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy have led to the introduction of gasless laparoscopy employing abdominal wall lifting (AWL) method. However, AWL has been criticized for its complexity and technical difficulty. We have used AWL method for gasless laparoscopic cholecystectomy and compared it with laparoscopic cholecystectomy with respect to operation performance, postoperative course, and pathophysiologic changes. During a four-month period, 40 consecutive patients with symptomatic gallstones were randomly assigned to receive laparoscopic cholecystectomy with conventional CO2 pneumoperitoneum (PP group; N=20) or the AWL method (AWL group; N=20). Operative results and operative time were recorded. Cardiopulmonary and ventilatory functions were assessed during the surgery. Postoperative pain and presence of nausea and vomiting were assessed for 48 hours after surgery. Postoperative time to recovery of flatus, tolerance to a full oral diet, and full activity were also determined. The intraoperative cardiopulmonary and ventilatory functions deteriorated significantly less in the AWL group. The preparation time for surgery and total operative time were significantly greater in the AWL group. None of the patients in either group required conversion to open surgery. Technique related morbidity was minimal and there was no mortality in either group. Although AWL method required a longer operation time, our results suggest that the technique is valuable in high-risk patients with cardiorespiratory disease. AWL technique of laparoscopic cholecystectomy is a feasible, safe and effective alternative to CO2 pneumoperitoneum. It probably costs less and is therefore, more useful in developing countries