The quality of evidence is downgraded by study limitations (unclear allocation concealment and lack of blinding) and by imprecise results (limited study size for each comparison).
A Cochrane review included a total of 5 trials with 130 participants (all with low anaesthetic risk) scheduled for elective laparoscopic cholecystectomy to abdominal wall lift with pneumoperitoneum versus pneumoperitoneum only. There was no mortality or conversion to open cholecystectomy in any of the participants in the trials that reported these outcomes. There was no significant difference in the rate of serious adverse events between the two groups (two trials; 2/29 events (0.069 events per person) versus 2/29 events (0.069 events per person); rate ratio 1.00; 95% CI 0.17 to 5.77). There was no significant difference in the operating time between the two groups (four trials; 53 participants versus 54 participants; 13.39 minutes longer (95% CI 2.73 less to 29.51 minutes longer) in the abdominal wall lift with pneumoperitoneum group and 100 minutes in the pneumoperitoneum group).
For abdominal wall lift versus pneumoperitoneum, 18 trials with a total of 774 participants (the majority with low anaesthetic risk) scheduled for elective laparoscopic cholecystectomy were randomised to abdominal wall lift without pneumoperitoneum versus pneumoperitoneum. There was no mortality in any of the trials that reported this outcome. There was no significant difference in the proportion of participants with serious adverse events (six trials; 5/172 (weighted proportion 2.4%) versus 2/171 (1.2%); RR 2.01; 95% CI 0.52 to 7.80). There was no significant difference in the rate of serious adverse events between the two groups (three trials; 5/99 events (weighted number of events per person = 0.346 events) versus 2/99 events (0.020 events per person); rate ratio 1.73; 95% CI 0.35 to 8.61). There was no significant difference in the proportion of people who underwent conversion to open cholecystectomy (11 trials; 5/225 (weighted proportion 2.3%) versus 7/235 (3.0%); RR 0.76; 95% CI 0.26 to 2.21). The operating time was significantly longer in the abdominal wall lift group than in the pneumoperitoneum group (16 trials; 6.87 minutes longer (95% CI 4.74 minutes to 9.00 minutes longer) in the abdominal wall lift group versus 75 minutes in the pneumoperitoneum group). There was no significant difference in the proportion of people discharged as laparoscopic cholecystectomy day-patients (two trials; 15/31 (weighted proportion 48.5%) versus 9/31 (29%); RR 1.67; 95% CI 0.85 to 3.26).
included 24 studies with a total of 910 subjects comparing abdominal wall lift (with or without pneumoperitoneum) versus pneumoperitoneum. The abdominal wall lift (lifting the front wall of the abdomen by using special instruments) was introduced to laparoscopic surgery primarily as a method to reduce the cardio-pulmonary changes which are seen with a carbon dioxide pneumoperitoneum. In 6 studies (n = 165) abdominal lift and pneumoperitoneum at very low pressure was compared to ordinary pneumoperitoneum.There was no mortality or conversion to open cholecystectomy. There was no difference in the rate of serious adverse events (2 trials; 2/29 events versus 2/29 events; rate ratio 1.00; 95% CI 0.17 to 5.77) or in the operating time between the two groups (4 trials; 53 patients versus 54 patients; 13.39 minutes longer (2.73 less to 29.51 longer) between the two groups.16 studies (n = 649) compared abdominal wall lift without pneumoperitoneum to pneumoperitoneum in elective laparoscopic cholecystectomy. The cardiopulmonary changes were less in abdominal wall lift with pneumoperitoneum at very low pressure and in abdominal lift without pnaumoperitoneum than in ordinary pneumoperitoneum. There was no difference in the morbidity and pain between the groups. The operating time was prolonged in abdominal wall lift compared with pneumoperitoneum (6.87 minutes longer (4.74 to 9.00 longer) .
Comment: Abdominal wall lift may have a role in decreasing the peri-operative cardiopulmonary complications in patients with cardiopulmonary diseases but this has not been demonstrated at the present time.