The use of laparoscopic insufflation modifies mechanical power in laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy requires pneumoperitoneum, which alters respiratory mechanics and may increase the risk of ventilator-induced lung injury. Objective: To evaluate the effect of laparoscopic insufflation on mechanical power (MP) and its association with ventilatory pressures and post-operative pulmonary complications (PPCs). Material and methods: A prospective cohort study was conducted with 52 patients undergoing laparoscopic cholecystectomy. Ventilatory parameters, including tidal volume, respiratory rate, plateau pressure, and driving pressure, were measured before and after insufflation. MP was calculated using a validated formula. Statistical analyses included paired Wilcoxon rank tests and subgroup analysis based on age, sex, and body mass index (BMI). Results: MP and driving pressure significantly increased post-insufflation (p = 9.2 × 10⁻7 and p = 2.5 × 10⁻10, respectively). Although no patient exceeded the 12 J/min threshold, patients aged > 60 years and those with a BMI ≥ 25 exhibited greater increases in ventilatory pressures, indicating a higher susceptibility to PPCs. Lung-protective ventilation strategies (6-7 mL/kg PBW) were consistently used. Conclusions: Laparoscopic insufflation significantly impacts respiratory mechanics, particularly MP and driving pressure. MP may be a useful predictor of intraoperative lung strain, and individualized ventilation strategies are essential to optimize outcomes and minimize PPC risks.