Clinical outcomes of low‑pressure pneumoperitoneum in minimally invasive urological surgery

Alexander West, John Hayes, D E Bernstein, Mahesh Krishnamoorthy, Steven Lathers, Gary Tegan, Jeremy Yuen-Chun Teoh, Prokar Dasgupta, Karel Decaestecker , Nikhil Vasdev

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Abstract

The adoption of minimally invasive laparoscopic techniques has revolutionised urological practice. This necessitates a pneumoperitoneum (PNP) and the impact the PNP pressure has on post-operative outcomes is uncertain. During the currentCOVID-19 era guidance has suggested the utilisation of lower PNP pressures to mitigate the risk of intra-operative viral transmission. Review the current literature regarding the impact of pneumoperitoneum pressure, within the field of urology, on post-operative outcomes. A search of the PubMed, Medline and EMBASE databases was undertaken to identify studies that met the inclusion criteria. The Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines were adhered to. Ten studies, that included both randomised controlled trials and retrospective case series reviews, were identified that met the inclusion criteria. The effect of PNP pressure on outcomes following prostatectomy, live donor nephrectomy, partial nephrectomy and a variety of benign upper tract procedures were discussed. Low pressure PNP appears safe when compared to high pressure PNP, potentially reducing post-operative pain and rates of ileus. When compared to general surgery, there is a lack of quality evidence investigating the impact of PNP pressures on outcomes within urology. Low pressure PNP appears non-inferior to high pressure PNP. More research is required to validate this finding, particularly post-cystectomy and nephrectomy.
Original languageEnglish
Number of pages10
JournalJournal of robotic surgery
Early online date30 Jan 2022
DOIs
Publication statusE-pub ahead of print - 30 Jan 2022

Keywords

  • Insufflation pressure
  • Minimally invasive surgery
  • Oncology
  • Pneumoperitoneum
  • Urology

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