Surgical Endoscopy

, Volume 16, Issue 7, pp 1121–1143

The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery

Authors

  • J. Neudecker
    • Conference Organizers on behalf of the Scientific Committee of the European Association for Endoscopic Surgery (E.A.E.S.), c/o E.A.E.S. Office, Post Office Box 335, 5500 AH Veldhoven, The Netherlands
    • Department of Surgery, Charité Campus Mitte, Humboldt-University of Berlin, Schumannstraße 20/21, 10117 Berlin, Germany
    • Biochemical and Experimental Division, 2nd Department of Surgery, University of Cologne, Ostmerheimer Strasse 200, 51109 Cologne, Germany
  • S. Sauerland
    • Conference Organizers on behalf of the Scientific Committee of the European Association for Endoscopic Surgery (E.A.E.S.), c/o E.A.E.S. Office, Post Office Box 335, 5500 AH Veldhoven, The Netherlands
    • Biochemical and Experimental Division, 2nd Department of Surgery, University of Cologne, Ostmerheimer Strasse 200, 51109 Cologne, Germany
  • E. Neugebauer
    • Conference Organizers on behalf of the Scientific Committee of the European Association for Endoscopic Surgery (E.A.E.S.), c/o E.A.E.S. Office, Post Office Box 335, 5500 AH Veldhoven, The Netherlands
    • Biochemical and Experimental Division, 2nd Department of Surgery, University of Cologne, Ostmerheimer Strasse 200, 51109 Cologne, Germany
  • R. Bergamaschi
    • Department of Surgery, SSSF Hospital, University of Bergen, 6800 Förde, Norway
  • H. J. Bonjer
    • Department of Surgery, University Hospital Dijkzigt, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
  • A. Cuschieri
    • University Department of Surgery, Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom
  • K-H. Fuchs
    • Department of Surgery, University of Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany
  • Ch. Jacobi
    • Conference Organizers on behalf of the Scientific Committee of the European Association for Endoscopic Surgery (E.A.E.S.), c/o E.A.E.S. Office, Post Office Box 335, 5500 AH Veldhoven, The Netherlands
  • F. W. Jansen
    • Department of Gynecology, Leiden University, Post Office Box 9600, 2300 RC Leiden, The Netherlands
  • A-M. Koivusalo
    • Department of Anaesthesia, University of Helsinki, 00130 Helsinki, Finland
  • A. Lacy
    • Department of Surgery, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain
  • M. J. McMahon
    • Leeds Institute for Minimally Invasive Therapy (LIMIT), Great George Street, Leeds LS1 3EX, United Kingdom
  • B. Millat
    • Department of Surgery, Hôpital Saint Eloi, Avenue Bertin Sans No. 2, 34295 Montpellier, France
  • W. Schwenk
    • Conference Organizers on behalf of the Scientific Committee of the European Association for Endoscopic Surgery (E.A.E.S.), c/o E.A.E.S. Office, Post Office Box 335, 5500 AH Veldhoven, The Netherlands
Article

DOI: 10.1007/s00464-001-9166-7

Cite this article as:
Neudecker, J., Sauerland, S., Neugebauer, E. et al. Surg Endosc (2002) 16: 1121. doi:10.1007/s00464-001-9166-7

Abstract

Background: The pneumoperitoneum is the crucial element in laparoscopic surgery. Different clinical problems are associated with this procedure, which has led to various modifications of the technique. The aim of this guideline is to define the scientifically proven standards of the pneumoperitoneum. Methods: Based on systematic literature searches (Medline, Embase, and Cochrane), an expert panel consensually formulated clinical recommendations, which were graded according to the strength of available literature evidence. Recommendations: Preoperatively, all patients should be assessed for the presence of cardiac, pulmonary, hepatic, renal, or vascular comorbidity. Presupposing appropriate perioperative measures and surgical technique, there is no reason to contraindicate pneumoperitoneum in patients with peritonitis or intraabdominal malignancy. During laparoscopy, monitoring of end tidal CO2 concentration is mandatory. The available data on closed- (Veress needle) and open-access techniques do not allow us to principally favor the use of either technique. Using 2 to 5-mm instead of 5 to 10-mm trocars improves cosmetic result and postoperative pain marginally. It is recommended to use the lowest intraabdominal pressure allowing adequate exposure of the operative field, rather than using a routine pressure. In patients with limited cardiac, pulmonary, or renal function, abdominal wall lifting combined with low-pressure pneumoperitoneum might be an alternative. Abdominal wall lifting devices have no clinically relevant advantages compared to low-pressure (5–7 mmHg) pneumoperitoneum. In patients with cardiopulmonary diseases, intra- and postoperative arterial blood gas monitoring is recommended. The clinical benefits of warmed, humidified insufflation gas are minor and contradictory. Intraoperative sequential intermittent pneumatic compression of the lower extremities is recommended for all prolonged laparoscopic procedures. For the prevention of postoperative pain a wide range of treatment options exists. Although all these options seem to reduce pain, the data currently do not justify a general recommendation.

Copyright information

© Springer-Verlag New York Inc. 2002