Intervention
Pain, pain
BLOOD, TUMOUR NECROSIS, PNEUMOPERITONEUM
Those in the intervention group were scheduled to undergo laparoscopic cholecystectomy at a low-pressure pneumoperitoneum defined as gas insufflation set point between 8 and 10 mmHg, and those in the control group were scheduled to undergo laparoscopic cholecystectomy at a standard-pressure pneumoperitoneum defined as gas insufflation set point between 12 and 14 mmHg. Surgery initiation pressure was started at 8 mmHg for low-pressure group, and 12 mmHg for standard- pressure group, when requested by the surgeon, the pressure was raised by two points each time. Trocars were inserted on the pressure assigned by each group.Method of pneumoperitoneum induction was left for the operating surgeon to decide as per trained, closed technique was done using veress needle, open technique was done with an infra-umbilical incision and insufflation of abdomen after 12 mm trocar insertion, optical technique utilized 12 mm optiview trocar. The trocars position was inserted for the four-trocar technique at 12 mm umbilical, 12 mm sub xiphisternum, 5 mm medial subcostal, and 5 mm lateral subcostal. For the three-trocar technique one 5 mm trocar was inserted subcostal instead of two. Trocars were introduced the the pressure set for each study group. Each operator adhered to steps of safe laparoscopic cholecystectomy with use of critical view of safety method.Pain scores were assessed using the 11-point short pain scale (SPS-11) according to patient perception at 6 h, 12 h, 24 h, and 7th day post-operatively.The following inflammatory markers were investigated: white blood cell (WBC) count (10^3 cells/mm), platelet (Plt) count (10^9/L), erythrocyte sedimentation rate (ESR) (millimetres per hour), C reactive protein (CRP) level (mg/L), albumin (Alb) level (g/dL), free serum cortisol level (nmol/L), interleukin − 6 (IL-6) level (pg/mL), interleukin − 17 (IL-17) level (pg/mL), interleukin − 1 beta (IL-1β) level (pg/mL), tumour necrosis factor alpha (TNF-α) level (pg/mL). Blood samples were withdrawn at the morning of surgery as baseline for all inflammatory markers. Four hours post-op cortisol levels were reassessed. Twenty-four hours post-op the remining markers were reassessed.