Gasless laparoscopy versus conventional laparoscopy and laparotomy. A systematic review on the safety and efficiency

Abstract Background Gasless laparoscopy emerged to overcome the clinical and financial challenges of pneumoperitoneum and is often seen as a viable option for use in resource-limited settings as a means of saving costs and resources. This study aims to systematically review the evidence available on the safety and efficiency of gasless laparoscopy compared to conventional laparoscopy and laparotomy.Methods Following PRISMA guidelines, Medline, Embase, Web of Science and Cochrane were searched. Variables of interest were determined a priori and Covidence software was used to screen studies for inclusion without demographic preference. The quality of studies was assessed using the Cochrane Risk Assessment tool.Results Of 1080 screened studies a total of 43 studies were included. Laparoscopic cholecystectomy was by far the most studied intervention in randomized studies. In these, the mean set-up time for gasless and conventional laparoscopy was 13.14 (95% CI: -0.16–26.44) and 12.8 (95% CI: -10.86–36.47) minutes respectively; The mean duration of surgery for gasless and conventional laparoscopy was 89.39 (95% CI: 77.44-101.34) and 72.59 (95% CI: 63.44–81.74) minutes respectively and the mean length of stay was 4.25 (95% CI: 2.02–6.48) and 4.04 (95% CI: 1.72–6.36) days respectively. Most reported complications were hemorrhage and infection with no assessable statistical difference.Conclusions Although gasless laparoscopy seems to be a feasible approach for many general surgery interventions, the observed outcomes based on safety and efficiency don’t suffice to recommend gasless laparoscopy as an alternative to conventional laparoscopy or laparotomy. Larger randomized trials with a low risk of bias are warranted.