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EAES Guidelines for Endoscopic Surgery - part 3

bằng chứng mạnh RCT thuận lợi cho các can thiệp; + +, Một số bằng chứng RCT Trong ủng hộ can thiệp + / 0, mâu thuẫn bằng chứng Trong RCT ủng hộ can thiệp + không RCT bằng chứng trong lợi của can thiệp, 0 Một số bằng chứng cho không RCT hiệu quả của can thiệp (0) không RCT bằng chứng về ảnh hưởng của không can thiệp; | Table 2.6 continued Open-acces technique Smaller trocars 3.5 mm Warmed insufflation gas Helium argon or NO2 Low-pressure laparoscopy Gasless laparoscopy Intraperitoneal anaesthetics Drowsiness and fatigue 0 0 276 0 0 155 178 271 Cosmetic results 276 0 0 0 0 0 Incisional hernia 0 0 0 0 0 Adhesions 0 0 0 0 0 Infections 0 0 0 0 0 0 strong RCT evidence in favour of intervention some RCT evidence in favour of intervention 0 conflicting RCT evidence in favour of intervention non-RCT evidence in favour of intervention 0 some RCT evidence for no effect of intervention 0 non-RCT evidence for no effect of intervention - non-RCT evidence against intervention - 0 conflicting RCT evidence against intervention - some RCT evidence against intervention - strong RCT evidence against intervention no valid research evidence available J. Neudecker et al. 2 The EAES Clinical Practice Guidelines on the Pneumoperitoneum for Laparoscopic Surgery 63 formed. Since gasless laparoscopy also requires excellent surgical expertise its use should be restricted to certain subgroups of surgeons and patients. Size of Access Devices Smaller access devices 5 mm in laparoscopy are only feasible in selected group of patients. The use of 2-5-mm instead of 5-10-mm access devices improves cosmetic result and postoperative pain marginally in laparoscopic cholecystectomy grade A . Although it has been assumed that smaller access devices may markedly improve the patients outcome of laparoscopic surgery this has not been shown in valid RCTs lb 22 . Merely modest advantages have been reported concerning a better cosmetic result lb 276 and less postoperative pain lb 22 35 46 276 4 192 after laparoscopic cholecystectomy. Postoperative pulmonary function and fatigue were unchanged lb 276 . Other clinical trials found a shorter convalescence by using smaller access devices in laparoscopic procedures 4 192 . The incidence of postlaparoscopic incisional hernia is less than 1 4 165 169 . whether smaller access devices