接受頭低腳高擺位之腹腔鏡手術患者在標準氣腹壓下與低氣腹壓下術後恢復與疼痛之比較

¹邱伯涵

¹台北醫學大學附設雙和醫院 泌尿科

Comparison of the outcomes of low-pressure and standard-pressure pneumoperitoneum among patients during laparoscopic surgery with Trendelenburg position

¹Po-Han Chiu

¹Department of Urology, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan

Purpose: The aim of this systematic review and meta-analysis was to demonstrate the outcome of standard and low intra-abdominal pressure (IAP) during laparoscopic surgery in steep Trendelenburg position.

Methods: Relevant studies published before December 2022 will be identified from the PubMed, Embase, and Cochrane databases. The following Medical Subject Headings terms will be used: pneumoperitoneum OR intra-abdominal pressure OR insufflation pressure OR pneumoperitoneum pressure AND laparoscopic surgery. The “related articles” option in PubMed will be used to broaden the search, and all abstracts, studies, and citations retrieved will be reviewed.

Results: Total pneumoperitoneum time and total blood loss during surgery between low IAP and standard IAP were not significantly different in patients undergoing robotic radical prostatectomy, laparoscopic colorectal surgery and gynecologic laparoscopy surgery. The postoperative pain at post anesthesia care unit (PACU) were significantly lower in low IAP group compared to standard IAP group. (MD -0.63; 95% CI: −0.87−0.40)

Conclusion: In clinical practice, laparoscopic surgery in steep Trendelenburg position combined with increased pressure of pneuoperitoneum can improve visualization, shorten operation time, and reduce blood loss. Our study demonstrates the outcome of standard and low IAP during laparoscopic surgery in steep Trendelenburg position, did not increase the risk or difficulty during laparoscopic surgery. The postoperative pain at PACU were significantly lower in low IAP group compared to standard IAP group, furthermore the postoperative pain at PACU were significantly lower in low IAP group compared to standard IAP group.