Comparison between CO2 insufflation and abdominal wall lift in laparoscopic cholecystectomy. A prospective multiinstitutional study in Japan.

BACKGROUND

Abdominal wall lift (AWL) was developed mainly in Japan to avoid insufflation-related complications and to improve cost performance. AWL, however, has been criticized for its poor visibility in obese patients, the complexity of preparing the lifting instruments, and increased inflammatory reactions. As experience with AWL has increased, proponents of the procedure have come to believe that AWL is simple enough to qualify as a standard method of laparoscopic surgery even in obese patients. Postoperatively, issues such as pain, changes in body temperature, and time before returning to work do not appear to be much different from those after CO2 insufflation.

METHODS

Twenty-three institutions participated in a prospective study to compare the effects of insufflation and AWL on surgical performance and postoperative course of laparoscopic surgery. Biochemical markers were also investigated including inflammatory responses. The patients were allocated to the participants to prevent experience-biases. A total of 144 patients were reviewed.

RESULTS

Background factors such as male-female ratio, age and body-mass index were similar in each group. The incidence of conversion-to-open was not significantly different between insufflation and AWL. Preparation time and operating time were not significantly different, either. Serum CPK showed a significantly higher value one day after peritoneal lift than after subcutaneous lift. CPK level after insufflation was between that of peritoneal lift and after subcutaneous lift. Differences in changes of plasma interleukin 6 and other surgical stress markers were not observed.

CONCLUSIONS

This prospective study, although not randomized, suggests that, except for invasiveness to the muscular layers of the abdominal wall, there may be no substantial difference between AWL and insufflation or among subcutaneous lift, peritoneal lift or insufflation in terms of morbidity, mortality, preparation time, operating time, inflammatory reactions, and postoperative clinical course.