title: Randomized comparison of conventional carbon dioxide insufflation and abdominal wall lifting for laparoscopic cholecystectomy.
abstract: BACKGROUND
  Gasless laparoscopy using abdominal wall lifting (AWL) has been developed in an attempt to avoid the adverse effects of carbon dioxide pneumoperitoneum that may occur in conventional laparoscopy. However, lifting has been criticized for its poor operative space and surgical invasiveness. This study compared the AWL method with conventional CO2 pneumoperitoneum for laparoscopic cholecystectomy with respect to operation performance, postoperative course, and stress response.
  
  
  METHODS
  During a 6-month period, 95 patients with symptomatic gallstones were randomly assigned to receive laparoscopic cholecystectomy with conventional CO2 pneumoperitoneum (CO2 group; N = 47) or the AWL method (AWL group; N = 48). Operative results and operative time were recorded. Cardiopulmonary functions were assessed, and arterial blood gases were analyzed during surgery. Urinary cortisol, vanillylmandelic acid, metanephrines, and nitrogen loss; serum complement 3, C-reactive protein, and interleukin-6; postoperative pain; and the presence of nausea and vomiting were assessed for 48 hours after surgery. Postoperative time to recovery of flatus, tolerance of a full oral diet, and full activity were also determined.
  
  
  RESULTS
  Only three significant differences were found. First, intraoperative ventilatory function deteriorated significantly less in the AWL group. Second, arterial blood gas determinations and capnography showed a greater decrease in intraoperative arterial pH and compliance with CO2 retention and an increase in peak airway pressure in the CO2 group (P < 0.05), reflecting poorer ventilatory performance. Third, preparation time and total operating time were significantly greater with the AWL method (P < 0.05).
  
  
  CONCLUSIONS
  Although AWL required a longer operation time, our results suggest that the technique may still have value in high-risk patients with cardiorespiratory diseases.
authors.affiliation: Department of Surgery, Chi-Mei Foundational Medical Center, Yung-Kang City, Tainan, Taiwan, ROC. cmh7500@chimei.org.tw
authors.forename: Yih-Huei
authors.initials: YH
authors.lastname: Uen
authors.forename: An-I
authors.initials: AI
authors.lastname: Liang
authors.forename: Hao-Hsien
authors.initials: HH
authors.lastname: Lee
mesh_terms: D002245:Carbon Dioxide / Q000008:administration & dosage; D016009:Chi-Square Distribution; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D012129:Respiratory Function Tests; D016896:Treatment Outcome
chemical_list: D002245:Carbon Dioxide