Summary of ‘Impact of low-pressure pneumoperitoneum on post-operative pain in robotic urological surgery: a systematic review’
The systematic review conducted by Yama Baheer and colleagues delves into the impact of low-pressure pneumoperitoneum on post-operative pain in robotic urological surgeries, highlighting its implications on patient recovery and pain management. The article notes that robotic technology has significantly transformed minimally invasive urological surgery, improving precision and reducing complications. However, the effect of lower pneumoperitoneum pressures on post-operative pain has not been thoroughly examined until now.
Study Objectives and Methodology
The primary objective of this review was to investigate how varying levels of pneumoperitoneum pressure affect post-operative pain. Secondary outcomes included post-operative opioid consumption, total operating time, estimated intra-operative bleeding, and length of hospital stay. The authors adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines during their study. They conducted extensive searches across multiple databases, including PubMed and Cochrane Central, and identified nine studies that met their inclusion criteria, focusing mainly on prostatectomy, with additional studies on partial nephrectomy and cystectomy.
Key Findings
The review revealed that low-pressure pneumoperitoneum, particularly during robotic-assisted urological surgeries, led to reduced post-operative pain scores, especially in the immediate recovery phase and on the first post-operative day (POD1). Despite these promising findings, the consumption of opioids did not significantly decrease, indicating that while patients experienced less pain, their use of pain relief medications remained consistent with standard pneumoperitoneum pressures.
Lower pneumoperitoneum pressures were demonstrated to maintain adequate surgical visibility without compromising the surgical workspace. This aspect is crucial, as it reassures surgeons that lowering pressure does not hinder the effectiveness of the procedure. The findings suggest that utilizing low-pressure pneumoperitoneum can promote more favourable immediate post-operative pain outcomes without increasing complication rates.
Limitations and Areas for Future Research
The review notes the limitations of the included studies, primarily due to the heterogeneity in definitions of ‘low-pressure pneumoperitoneum’ and varied methodologies for measuring pain. The majority of studies also exhibited a moderate risk of bias, which calls for caution in interpreting the results. The authors emphasize the need for further research, particularly in the areas of partial nephrectomy and cystectomy, to solidify the understanding of low-pressure pneumoperitoneum’s impact.
Conclusion
In conclusion, Baheer et al. present early evidence suggesting that low-pressure pneumoperitoneum can reduce immediate post-operative pain scores in robotic-assisted urological surgeries, potentially leading to improved recovery experiences. However, the lack of reduction in opioid consumption highlights an area that necessitates further exploration. The review underscores the importance of continuing research to establish definitive guidelines and protocols for the application of low-pressure pneumoperitoneum in surgical practice, thereby enhancing patient outcomes in urology.
READ MORE… https://link.springer.com/article/10.1007/s11701-025-02221-8
