Low-pressure pneumoperitoneum during laparoscopic donor nephrectomy to optimize live donors' comfort.
Warle MC, Berkers AW, et al.Clinical Transplantation 2013;27(4):E478-83
Aims
To compare low versus standard pressure pneumoperitoneum during laparoscopic donor nephrectomy.
Interventions
Patients were randomised to receive standard pressure or low pressure pneumoperitoneum.
Participants
20 patients undergoing laparoscopic donor nephrectomy.
Outcomes
The outcomes included nausea, and pain which was sub divided into superficial wound pain, deep intra-abdominal pain, and referred shoulder pain. Other outcomes included length of hospitalisation, and post operative complications within the first month, donor serum creatinine levels, difficulty and progression quantified by the surgeon. Heart rate, mean arterial pressure, minute ventilation, respiratory rate, positive inspiratory pressure and end-tidal carbon dioxide, urine output and infusion were also recorded.
Follow-up
1 month.
CET Conclusions
This randomised, blinded study investigates the use of low-pressure (7mmHg) versus normal pressure (14mmHg) pneumoperitoneum for laparoscopic living donor nephrectomy. The authors find that cumulative pain scores are higher in the standard pressure group, whilst operating time was longer in the low-pressure group. Two of the ten patients in the low-pressure group required conversion to high-pressure due to bleeding or lack of progress. Whilst the study design is generally quite good, to sample size (10 patients per arm) is far too small to draw any firm conclusions – the sheer number of comparisons made and the small number of included patients means that the risk of type I error is high. This is evidenced in the imbalance resulting from randomisation: there are 7 female donors in the standard-pressure group compared to just three in the low-pressure group. As females have been shown in multiple studies to have a lower pain threshold than males, it is perhaps not surprising that pain scores were higher in the standard-pressure arm. Furthermore, there were 6 patients with multiple arteries in the lower-pressure group versus none in the standard-pressure group, which can be expected to result in longer operating times.
Data analysis
Strict intention-to-treat analysis
Trial registration
Not reported.