Low-pressure pneumoperitoneum—why and how

: In the field of laparoscopic surgery, there has been ongoing discussion regarding the optimal pressure for pneumoperitoneum. Until recently, there was limited data available regarding the effects of low-pressure versus standard-pressure pneumoperitoneum on intraoperative and postoperative outcomes. However, a consensus has been established in most institutions, designating 12 mmHg as the standard pressure for laparoscopy, despite the existence of data on the beneficial effects of lower pressure levels without compromising patient safety. In order to achieve the lowest possible pressure for pneumoperitoneum without compromising patient safety, certain approaches have been suggested. Deep neuromuscular blockade has been proposed as a technique to reduce intraabdominal pressure by inducing muscle relaxation, allowing for lower insufflation pressures while maintaining adequate surgical exposure. This approach has shown promising results in terms of improving postoperative outcomes. However, further studies are needed to validate its efficacy and determine the optimal level of neuromuscular blockade required. In conclusion, the optimal pressure for pneumoperitoneum in laparoscopic surgery has been a subject of ongoing debate and research. Recent evidence suggests that low-pressure pneumoperitoneum may offer advantages in terms of reduced postoperative pain, analgesic consumption, and shoulder pain, without significant increases in complications or conversion rates. However, further studies are needed to fully elucidate the effects of low-pressure pneumoperitoneum on various surgical procedures and patient populations. As laparoscopic surgery continues to evolve, a multidisciplinary approach involving surgeons, anesthesiologists, and researchers is essential to refine techniques and optimize patient care.