title: Low vs standard pneumoperitoneum pressure during laparoscopic hysterectomy: prospective randomized trial.
abstract: OBJECTIVE
  To compare the use of low pneumoperitoneum pressure (LPP; 8 mm Hg) vs standard pneumoperitoneum pressure (SPP; 12 mm Hg) during mini-laparoscopic hysterectomy (MLH).
  
  
  METHODS
  Randomized controlled trial (Canadian Task Force classification I).
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Forty-two consecutive women scheduled to undergo MLH to treat benign uterine disease.
  
  
  METHODS
  Women were randomly selected to undergo MLH using LPP (n = 20) or SPP (n = 22). MLH was performed via 3-mm ancillary ports.
  
  
  RESULTS
  The primary outcome was to evaluate changes in abdominal and shoulder-tip pain via a 100-mm visual analog scale at 1, 3, and 24 hours postoperatively. All procedures were completed via mini-laparoscopy without the need to increase intra-abdominal pressure or convert to conventional laparoscopy or open surgery. Intraoperatively, 1 episode of severe bradycardia occurred in the LPP group, whereas no intraoperative complications were recorded in the SPP group (p = .47). No postoperative complications were recorded (p > .99). Abdominal pain was similar between groups at each time point. Incidence and intensity of shoulder-tip pain at 1 and 3 hours postoperatively was lower in the LPP group than in the SPP group (p < .05), whereas no between-group differences were observed at 24 hours (p > .05). Rescue analgesic requirement did not differ statistically between the LPP and SPP groups (20% vs 41%, respectively; p = .19; odds ratio, 2.7; 95% confidence interval, 0.69-11.08).
  
  
  CONCLUSIONS
  In experienced hands, use of LPP is safe and feasible. During performance of MLH, compared with SPP, LPP is a simple method that offers advantages of less shoulder-tip pain.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Insubria, Del Ponte Hospital, Varese, Italy. Electronic address: giorgiobogani@yahoo.it.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bogani
authors.affiliation: Department of Obstetrics and Gynaecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Uccella
authors.affiliation: Department of Obstetrics and Gynaecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Cromi
authors.affiliation: Department of Obstetrics and Gynaecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Serati
authors.affiliation: Department of Obstetrics and Gynaecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
authors.forename: Jvan
authors.initials: J
authors.lastname: Casarin
authors.affiliation: Department of Obstetrics and Gynaecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Pinelli
authors.affiliation: Department of Obstetrics and Gynaecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Ghezzi
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology* / Q000517:prevention & control; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects / Q000379:methods*; D011312:Pressure; D011446:Prospective Studies; D020069:Shoulder Pain / Q000209:etiology* / Q000517:prevention & control
keywords: Hysterectomy; Laparoscopy; Mini-laparoscopy; Pain; Pneumoperitoneum pressure