title: Complications of low compared to standard pneumoperitoneum pressures in laparoscopic surgery for benign gynecologic pathology: a systematic review protocol.
abstract: BACKGROUND
  No definite consensus has been established about the optimal pressure for artificial pneumoperitoneum when performing laparoscopic surgery. It has been postulated that lowering intra-peritoneal pressure levels while performing general laparoscopic surgery would lower surgical complications including post-operative pain, but data remain scarce about significant operative complications. Furthermore, such data is not available for gynecologic laparoscopy. The objective of this systematic review is to compare the frequency and nature of significant operative complications of lower and standard pneumoperiteoneal pressure levels in gynecologic laparoscopic surgery for benign indications.
  
  
  METHODS
  We will search PubMed, Embase, the Cochrane Library, randomised control trials registries, and reference lists of included articles. Randomised controlled trials comparing different intra-peritoneal pressure levels in women undergoing gynecologic laparoscopic surgery for a non-malignant indication will be eligible. Two reviewers will independently select and review references, extract data, and assess quality from included studies. We will use RevMan5 to calculate risk ratios and their 95 % confidence intervals to compare the frequency of complications according to intra-peritoneal pressure levels. We will perform sensitivity analyses to explore heterogeneity potentially due to various operative characteristics or characteristics of patients.
  
  
  CONCLUSIONS
  Our results will help identify the optimal intra-peritoneal pressure level in gynecologic laparoscopic surgery and determine if lowering intra-peritoneal pressure levels while trying to achieve lower levels of post-operative pain is an acceptable change of practice according to the frequency and nature of significant complications.
  
  
  BACKGROUND
  
  CRD42015020231.
authors.affiliation: CHU de Québec-Université Laval Research Center, 2705, boulevard Laurier, Québec, QC, G1V 4G2, Canada. esther.b-kyle.1@ulaval.ca.|Department of Obstetrics-Gynaecology and Reproduction, Université Laval, 2325, rue de l'Université, Québec, QC, G1V 0A6, Canada. esther.b-kyle.1@ulaval.ca.
authors.forename: Esther B
authors.initials: EB
authors.lastname: Kyle
authors.affiliation: CHU de Québec-Université Laval Research Center, 2705, boulevard Laurier, Québec, QC, G1V 4G2, Canada. sarah.maheux-lacroix.1@ulaval.ca.|Department of Obstetrics-Gynaecology and Reproduction, Université Laval, 2325, rue de l'Université, Québec, QC, G1V 0A6, Canada. sarah.maheux-lacroix.1@ulaval.ca.
authors.forename: Sarah
authors.initials: S
authors.lastname: Maheux-Lacroix
authors.affiliation: Department of Social and Preventive Medicine, Université Laval, 2325, rue de l'Université, Québec, QC, G1V 0A6, Canada. amelie.boutin.2@ulaval.ca.
authors.forename: Amélie
authors.initials: A
authors.lastname: Boutin
authors.affiliation: CHU de Québec-Université Laval Research Center, 2705, boulevard Laurier, Québec, QC, G1V 4G2, Canada. madeleine.lemyre@fmed.ulaval.ca.|Department of Obstetrics-Gynaecology and Reproduction, Université Laval, 2325, rue de l'Université, Québec, QC, G1V 0A6, Canada. madeleine.lemyre@fmed.ulaval.ca.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Lemyre
mesh_terms: D000005:Abdomen / Q000601:surgery*; D002985:Clinical Protocols; D005260:Female; D006176:Gynecology / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology* / Q000517:prevention & control; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects* / Q000379:methods; D011312:Pressure / Q000009:adverse effects*; D012107:Research Design; D000078202:Systematic Reviews as Topic