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

Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, UK. Alexander.west2@nhs.net. Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, UK. Clinical Affairs, Largo, FL, USA. Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China. European Association of Urology, Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands. Faculty of Life Sciences and Medicine, King's College London, London, UK. Department of Urology, University of Ghent Hospital, Gent, Belgium. School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.

Journal of robotic surgery. 2022;:1-10
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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 current COVID-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.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine