Low pressure pneumoperitoneum in robotic surgery: a systematic review and meta-analysis.

Robotic surgery is traditionally performed with pneumoperitoneum pressure ranging from 12 to 15 mmHg. However, low pressure pneumoperitoneum (LPP) has been discussed as a valuable option to reduce perioperative complications. This study aims to evaluate the evidence comparing LPP to standard pressure pneumoperitoneum (SPP) in robotic surgery. We conducted a systematic review and meta-analysis searching in January 2025 in PubMed, Embase and Cochrane for studies comparing LPP (≤ 12 mmHg) with SPP (> 12mmHg) in robotic procedures (PROSPERO #CRD420251019755). Primary outcomes were operative time (OT) and postoperative ileus (POI). Secondary outcomes included estimated blood loss (EBL), pain on postoperative day one (POD1), length of stay (LOS), readmission rates, Clavien-Dindo (CD) grade I-II and III-IV complications. Thirteen studies comprising 2,675 patients were analyzed. OT was not statistically different between groups (MD 2.59; CI 95% −2.50 to 7.69; p = 0.32; I² 64%). POI was significantly lower in the LPP group (RR 0.43; CI 95% 0.25 to 0.73; p = 0.002; I²=0%). Other outcomes, including EBL, pain on POD1, LOS, readmission rates and CD grade I-II and III-IV complications showed no significant differences. Our findings suggest that LPP significantly reduces POI without impacting OT and other postoperative outcomes in robotic surgery.