***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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    ***EXAMPLES*** 
    Input: Background The incidence of shoulder pain ( SP ) following  laparoscopic cholecystectomy ( LC ) varies between 21 and 80 % . A few r and omised controlled trials and meta- analysis have shown lesser SP in LC performed under low-pressure carbon dioxide pneumoperitoneum ( LPCP ) than under st and ard-pressure carbon dioxide pneumoperitoneum ( SPCP ) . However , the possible compromise in adequate exposure and effective working space during LPCP has negatively influenced its uniform adoption for LC . Material s and methods All consecutive patients undergoing elective LC for gallstone disease who met the inclusion and exclusion criteria were enroled . Fourty patients were r and omised to SPCP group ( pressure of 14 mmHg ) and 40 to LPCP group ( pressure of 9–10 mmHg ) . Primary outcome measured was incidence of SP and its severity on visual analogue scale ( VAS ) at 4 , 8 , 24 h and 7 days after LC . Secondary outcomes measured were procedural time , technical difficulty , surgeons ’ satisfaction score on exposure and working space , intra-operative changes in heart rate and blood pressure , abdominal pain and analgesic requirement . Analyses were performed using Stata software . Results There was no conversion to open surgery , bile duct injury or need to increase intra-abdominal pressure on either group . Twenty-three patients ( 57.5 % ) in SPCP group and nine patients ( 22.5 % ) in LPCP group had SP ( p = 0.001 ) . The severity of SP was significantly more in SPCP group at 8 and 24 h ( p = 0.009 and 0.005 , respectively ) . Both the groups had similar procedural time , surgeons ’ satisfaction score , intra-operative changes in heart rate and blood pressure . Conclusion The incidence and severity of SP following LC performed at LPCP are significantly less compared to that in SPCP . The safety , efficacy and surgeons ’ satisfaction appear to be comparable in both the groups . Hence , a routine practice of low-pressure carbon dioxide pneumoperitoneum may be recommended in selected group of patients undergoing laparoscopic cholecystectomy . Clinical trial registration numbe rCT RI/2016/02/006590 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 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 BACKGROUND Abdominal pain and shoulder tip pain after laparoscopic cholecystectomy are distressing for the patient . Various causes of this pain are peritoneal stretching and diaphragmatic irritation by high intra-abdominal pressure caused by pneumoperitoneum . We design ed a study to compare the post operative pain after laparoscopic cholecystectomy  at  low pressure ( 7 - 8 mm of Hg ) and st and ard pressure technique ( 12 - 14 mm of Hg ) . Aim : To compare the effect of low pressure and st and ard pressure pneumoperitoneum in post laparoscopic cholecystectomy pain . Further to study the safety of low pressure pneumoperitoneum in laparoscopic cholecystectomy . SETTING S AND DESIGN A prospect i ve r and omised double blind study . MATERIAL S AND METHODS A prospect i ve r and omised double blind study was done in 100 ASA grade I & II patients . They were divided into two groups -50 each . Group A patients underwent laparoscopic cholecystectomy with low pressure pneumoperitoneum ( 7 - 8 mm Hg ) while group B underwent laparoscopic cholecystectomy with st and ard pressure pneumoperitoneum ( 12 - 13 mm Hg ) . Both the groups were compared for pain intensity , analgesic requirement and complications . STATISTICAL ANALYSIS Demographic data and intraoperative complications were analysed using chi-square test . Frequency of pain , intensity of pain and analgesics consumption was compared by applying ANOVA test . RESULTS Post-operative pain score was significantly less in low pressure group as compared to st and ard pressure group . Number of patients requiring rescue analgesic doses was more in st and ard pressure group . This was statistically significant . Also total analgesic consumption was more in st and ard pressure group . There was no difference in intraoperative complications . CONCLUSION This study demonstrates the use of simple expedient of reducing the pressure of pneumoperitoneum to 8 mm results in reduction in both intensity and frequency of post-operative pain and hence early recovery and better outcome .This study also shows that low pressure technique is safe with comparable rate of intraoperative complications 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 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 Abstract Background : Peritoneal insufflation to 15 mmHg diminishes venous return and reduces cardiac output . Such changes may be dangerous in patients with a poor cardiac reserve . The aim of this study was to investigate the hemodynamic effects of high ( 15 mmHg ) and low ( 7 mmHg ) intraabdominal pressure during  laparoscopic cholestectomy ( LC )  Methods : Twenty patients were r and omized to either high- or low-pressure capnoperitoneum . Anesthesia was st and ardized , and the end-tidal CO2 was maintained at 4.5 kPa . Arterial blood pressure was measured invasively . Heart rate , stroke volume , and cardiac output were measured by transesophageal doppler . Results : There were 10 patients in each group . In the high-pressure group , heart rate ( HR ) and mean arterial blood pressure ( MABP ) increased during insufflation . Stroke volume ( SV ) and cardiac output were depressed by a maximum of 26 % and 28 % ( SV 0.1 > p > 0.05 , cardiac output p > 0.1 ) . In the low-pressure group , insufflation produced a rise in MABP and a peak rise in both stroke volume and cardiac output of 10 % and 28 % , respectively ( p < 0.05 ) . Conclusions : Low-pressure pneumoperitoneum is feasible for LC and minimizes the adverse hemodynamic effects of peritoneal insufflation Introduction Intraabdominal CO2 gas after laparoscopic cholecystectomy causes postoperative shoulder-tip pain . Many methods of analgesia have been used to reduce this pain , including analgesic drugs , intraperitoneal local anesthetic , intraperitoneal saline , a gas drain , heated gas , low-pressure gas , and nitrous oxide pneumoperitoneum . The aim of this study was to evaluate the efficacy of combined low-pressure CO2 pneumoperitoneum and intraperitoneal infusion of normal saline in reducing the incidence of postoperative shoulder-tip pain . Methods Altogether , 109 patients undergoing elective laparoscopic cholecystectomy were r and omized prospect ively into three groups . Patients in group A ( n = 34 ) underwent laparoscopic cholecystectomy with 14 mmHg CO2 pneumoperitoneum ; patients in group B ( n = 37 ) underwent laparoscopic cholecystectomy with 10 mmHg CO2 pneumoperitoneum ; and those in group C ( n = 38 ) underwent laparoscopic cholecystectomy with 10 mmHg CO2 pneumoperitoneum in addition to intraperitoneal normal saline infusion in the right hemidiaphragmatic area . Shoulder-tip pain was recorded on a verbal rating scale 2 , 6 , 12 , 24 , and 48 hours after operation . Results Twelve patients in group A ( 35.2 percent ) , six in group B ( 16.2 percent ) , and seven in group C ( 18.4 percent ) complained of shoulder-tip pain . Hence , there was a significant decrease in the frequency of shoulder-tip pain in groups 
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High IAP was not associated with a significant difference for these outcomes when compared with st and ard or low IAP .
No significant differences were found between the IAP levels regarding need for conversion to open surgery ; post-operative acute bleeding , pain at 72 h , nausea , and vomiting ; and duration of surgery .
Our study of published trials indicates that using low , as opposed to st and ard , IAP during laparoscopic cholecystectomy may reduce patients ’ post-operative pain , including shoulder pain , and length of hospital stay .