***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Summary The study was carried out r and omly in 20 patients of ASA grade I and II of either sex , between the ages of 25 and 65 years scheduled for laparoscopic cholecystectomy . We studied the effect of intraperitoneal CO2 insufflation with head up position , on RR interval , QT interval , QTc interval , QT Dispersion , QTc Dispersion using computerized measurement with the help of 12 lead ECG . The RR interval did not change significantly during the study but there was statistically significant increase in QT interval , QTD and AIMS To investigate the incidence , risk factors and natural history of gallstone disease , a r and om sample of females belonging to a rural population was enrolled in a ten-year longitudinal study . METHODS The study has been performed in a small town on the hills south of Rome . In 1985 , a r and om sample of 426 females , aged 20 - 69 years , was screened by real-time ultrasonography for gallstones and previous cholecystectomy .  Screening methods included anthropometry , collection of a blood sample and a question naire on the occurrence of abdominal symptoms . During 1995 , all these subjects were invited for a 10-year follow-up examination . RESULTS The overall 10-year incidence of gallstone disease was 6.3 % ( 5.5 % of new gallstones and 0.8 % of cholecystectomies ) . Only 23.1 % of the women with gallstones were aware of their condition . More than three quarters ( 76.9 % ) had not suffered biliary pain . Univariate and multivariate analyses demonstrated a positive independent association of new gallstone disease with body mass index and parity . Out of the initially asymptomatic gallstone women , 15.4 % experienced at least one episode of biliary pain , 23.1 % were su bmi tted to elective cholecystectomy and 61.5 % remained asymptomatic . CONCLUSIONS The study demonstrates a high incidence of gallstone disease in women belonging to a rural free-living population in Italy and suggests body mass index and parity as possible true risk factors . Moreover , it confirms that a remarkable proportion of asymptomatic patients become symptomatic and eventually undergo cholecystectomy Background Post-laparoscopic pain syndrome is well recognized and characterized by abdominal and particularly shoulder tip pain ; it occurs frequently following laparoscopic cholecystectomy . The etiology of post-laparoscopic pain can be classified into three aspects : visceral , incision , and shoulder . The origin of shoulder pain is only partly understood , but it is commonly assumed that the cause is overstretching of the diaphragmatic muscle fibers owing to a high rate of insufflations . This study aim ed to compare the frequency and intensity of shoulder tip pain between  low-pressure ( 7 mmHg ) and st and ard-pressure  ( 14 mmHg ) in a prospect i ve r and omized clinical trial . Methods One hundred and forty consecutive patients undergoing elective laparoscopic cholecystectomy  were r and omized prospect ively to either high- or low-pressure pneumoperitoneum and blinded by research nurses who assessed the patients during the postoperative period . The statistical analysis included sex , mean age , weight , American Society of Anesthesiologists ( ASA ) grade , operative time , complication rate , duration of surgery , conversion rate , postoperative pain by using visual analogue scale , number of analgesic injections , incidence and severity of shoulder tip pain , and postoperative hospital stay . p < 0.05 was considered indicative of significance . Results The characteristics of the patients were similar in the two groups except for the predominance of males in the st and ard-pressure group ( controls ) . The procedure was successful in 68 of 70 patients in the low-pressure group compared with in 70 patients in the st and ard group . Operative time , number of analgesic injections , visual analogue score , and length of postoperative days were similar in both groups . Incidence of shoulder tip pain was higher in the st and ard-pressure group , but not statistically significantly so ( 27.9 % versus 44.3 % ) ( p = 0.100 ) . Conclusions Low-pressure pneumoperitoneum tended to be better than st and ard-pressure pneumoperitoneum in terms of lower incidence of shoulder tip pain , but this difference did not reach statistical significance following elective laparoscopic cholecystectomy Purpose . Laparoscopic cholecystectomy has been accepted as an alternative to laparotomy , but there is still controversy regarding the effects of pneumoperitoneum on splanchnic and hepatic perfusion . We assessed the effects of different insufflation pressures on liver functions by using indocyanine green elimination tests ( ICG-PDR ) . Methods . We analyzed 43 patients who were scheduled for laparoscopic cholecystectomy .  The patients were r and omly allocated to two groups . In Group I , the operation was performed using 10 mmHg pressure pneumoperitoneum . In Group II , 14 mmHg pressure pneumoperitoneum was used . The ICG-PDR measurements were made after induction ( ICG-PDR 1 ) and after the end of the operation ( ICG-PDR 2 ) . Serum aspartate aminotransferase ( AST ) , alanine aminotransferase ( ALT ) , and total bilirubin levels were all recorded preoperatively , 1 hour , and postoperative 24 hours after surgery . Results . The ICG-PDR 1 values for Groups I and II were as follows : 26.78 ± 4.2 % per min versus 26.01 ± 2.4 % per min ( P > 0.05 ) . ICG-PDR 2 values were found to be 25.63 ± 2.1 % per min in Group I versus 19.06 ± 2.2 % per min in Group II ( P < 0.05 ) . There was a statistically significant decrease between baseline and postoperative ICG-PDR values in Group II compared to Group I ( P < 0.05 ) . Statistically , there was an increase between baseline and postoperative 1st-hour serum AST and ALT level in Group II ( P < 0.05 ) compared to Group I. No statistical differences were detected on postoperative 24st-hour serum AST and ALT levels and all the time bilirubin between groups ( P > 0.05 ) . Conclusion . In conclusion , the results show that 14 mmHg pressure pneumoperitoneum decreased the blood flow to the liver and increased postoperative 1st-hour serum AST and ALT levels . We think that 10 mmHg pressure pneumoperitoneum is superior to 14 mmHg pressure pneumoperitoneum in laparoscopic cholecystectomy Laparoscopy using carbon dioxide insufflation induces adverse effects in both the cardiovascular and the respiratory function . The use of low pressure pneumoperitoneum has been shown to reduce adverse hemodynamic effects . However , its effect on tissue trauma and postoperative pain and recovery remains controversial . The aim of this study was to compare tissue trauma , postoperative pain , and recovery in two groups of patients undergoing laparoscopic cholecystectomy , one at insufflation pressure of 8 ( LC8 ) and the other at 15 mm Hg ( LC15 ) . Forty patients were r and omized , 20 in each group . The characteristics of the patients were similar in the two groups . The procedure was completed in all patients in the LC15 group , but in 2 patients in the LC8 group the pressure was increased to 15 mm Hg to complete the operation . There were no significant differences in postoperative pain scores , analgesic consumption , and the incidence of nausea , vomiting , and shoulder pain between the two groups . C-reactive protein concentrations and white blood cell count rose significantly after surgery , but the increase was similar in the two groups . The median duration of surgery was similar , 23 minutes ( range 15–65 ) in the LC8 group and 25 minutes ( range 15–80 ) in the LC15 group . Using our technique of laparoscopic cholecystectomy , there were no advantages to tissue damage , postoperative pain , and recovery when a low pressure pneumoperitoneum was used OBJECTIVE Immunosuppression is directly related to the degree of trauma . The aim of this study is to compare the effects of low and high intra-abdominal pressure on immune response in moderate surgical trauma . METHODS Twenty-two patients , scheduled for laparoscopic cholecystectomy  , were r and omly allocated to one of 2 groups according to intra-abdominal pressure :  low and high intra-abdominal pressure . This study was conducted in the Hacettepe University Faculty of Medicine , Operation Room , Ankara , Turkey .  Serum interleukin (IL)-2 and IL-6 levels were measured . RESULTS Serum IL-2 showed a significant decrease before the incision in high intra-abdominal pressure group . The increase in serum IL-6 at the end of surgery and postoperatively was lower in low intra-abdominal pressure group . CONCLUSION These results , can be interpreted as the immune system , are less depressed when there is lower intra-abdominal pressure . This may have clinical implication s in immunocompromised patients Postoperative shoulder‐tip pain occurs frequently following laparoscopic cholecystectomy . The aim of this r and omized clinical trial was to evaluate the efficacy of a low‐pressure carbon dioxide pneumoperitoneum during laparoscopic surgery in reducing the incidence of postoperative shoulder‐tip pain We have studied the cardiorespiratory changes produced by abdominal wall elevation ( AWE ) or carbon dioxide pneumoperitoneum ( PN ) in 20 women undergoing gynaecological laparoscopy .  Arterial pressure , heart rate , lung/chest complicance and blood-gas tensions were measured 10 min after induction of general anaesthesia ( T0 ) , 10 min after abdominal distension in the supine position ( T1 ) and 10 min after the Trendelenburg position was assumed ( T2 ) . Visual analogue scores for pain were recorded 1 and 6 h after the end of surgery . We found that lung/chest compliance was reduced significantly in group PN at T1 and T2 compared with both T0 and group AWE . Diastolic arterial pressure increased significantly in group PN at T1 and T2 compared with both T0 and group AWE , while it remained unchanged in group AWE . Arterial PCO2 increased significantly only in group PN after pneumoperitoneum , while oxygenation was almost unchanged in both groups . AWE patients had greater abdominal pain 1 h after surgery . Six hours after surgery pain was similar in the two groups . These data indicate that abdominal wall elevation reduced pulmonary compliance less than a pneumoperitoneum in patients undergoing gynaecological laparoscopy BACKGROUND Laparoscopic cholecystectomy ( LC ) has become the st and ard treatment for gall bladder disease . However , despite its low degree of invasiveness , many patients complain of postoperative pain and postoperative nausea/vomiting . This study was planned to evaluate different factors affecting the incidence and severity of postoperative shoulder-tip pain after LC . PATIENTS AND METHODS One hundred consecutive patients who were treated for gall bladder stone by LC at the Gastroenterology Surgical Center , Mansoura University , Mansoura , Egypt , during the period from October 2008 to January 2010 , were r and omized according to different pnemoperitonum pressures ( 8 , 10 , 12 , and 14 mm Hg ) . Each group comprises 25 patients . RESULTS There were 62 patients reported to have postoperative shoulder-tip pain during the first 12 hours after operation , which decreased to 9 patients on the 10th postoperative day . A significant difference was observed in the prevalence of pain at different pressures , 11 % with low pressure and increased to 20 % with high pressure . The incidence of shoulder-tip pain was significantly more in patients with a longer duration of the operation of > 45 minutes at 12 hours ( 23 [ 76.7 % ] versus 39 [ 55.7 % ] ; P = 0.04 ) , at 24 hours ( 23 [ 76.7 % ] versus 29 [ 41.4 % ] ; P = 0.009 ) , and at 3 days postoperatively ( 19 [ 63.3 % ] versus 20 [ 28.6 % ] ; P = 0.01 ) . The volume of used gases during the operation had no effect on the incidence or severity of shoulder-tip pain after LC . Also , the use of intraoperative analgesics had no effect on the incidence or severity of shoulder-tip pain after LC . CONCLUSIONS The origin of pain after LC is multifactorial . We recommend the use of the lower pressure technique during LC , and as patients with and without drains have similar incidence of postoperative shoulder pain , drains should not be used with the intention of preventing shoulder pain The so-called post-laparoscopic algesia is a specific impairment of about 63 % of the patients who undergo laparoscopic surgical operations . This impairment takes the form of mild to moderate shoulder pain . Eliminating the causes of pain has a clear advantage over symptomatic treatment using analgetics , a fact worth a good consideration especially with the post-operative sojourn at the hospital becoming shorter and shorter . In a prospect i ve controlled study , involving 42 patients subdivided into four groups namely , higher or lower insufflation pressures , chemically inert insufflation gas and control groups ; the use of analgetics , lung function , operation duration , amount of insufflated gas , intraperitoneal pH-values and post-operative complications in the various sub 
    Output:
    
Laparoscopic cholecystectomy can be completed successfully using low pressure in approximately 90 % of people undergoing laparoscopic cholecystectomy .
However , no evidence is currently available to support the use of low pressure pneumoperitoneum in low anaesthetic risk patients undergoing elective laparoscopic cholecystectomy .