Design: Double-blind randomised controlled trial
Population: 160 adults having elective laparoscopic cholecystectomy
Primary outcome: Pain (VAS) at 6 hours
Effect: Median 3 vs 4 (p = 0.22); paracetamol use slightly lower with 8 mmHg

A double-blind randomised trial in PLOS ONE, published on 9 October, assigned 160 patients having elective laparoscopic cholecystectomy to an insufflation pressure of 8 mmHg or the standard 14 mmHg.

Median pain scores at 6 hours were 3 vs 4 (p = 0.22), with no significant difference at 12 or 24 hours either. Paracetamol use over the first day was slightly lower with low pressure. Operating time was the same, and there were no conversions or major complications.

Low pressure was feasible and did not slow the operation, but the pain benefit, if any, is small. The trial was not large enough to judge rare surgical complications, which is the question that matters when visibility is reduced.

Low-pressure pneumoperitoneum is an option where the surgeon has adequate view, but expect at most a small pain benefit.
Continue multimodal analgesia regardless of insufflation pressure.
Agree the pressure with the surgeon before the case and raise it if the view is poor.
Use deep neuromuscular block if needed to maintain working space at low pressure.

Why it matters

It tempers enthusiasm for low-pressure laparoscopy as a pain-control strategy.

The statistics, in plain English

A one-point difference in median pain that is not statistically significant could be chance. A trial of 160 patients cannot detect differences in rare complications such as bile duct injury.