Comparison between CO2 insufflation and abdominal wall lift in laparoscopic cholecystectomy

Background: Abdominal wall lift (AWL) was developed mainly in Japan to avoid insufflation-related complications and to improve cost performance. AWL, however, has been criticized for its poor visibility in obese patients, the complexity of preparing the lifting instruments, and increased inflammatory reactions. As experience with AWL has increased, proponents of the procedure have come to believe that AWL is simple enough to qualify as a standard method of laparoscopic surgery even in obese patients. Postoperatively, issues such as pain, changes in body temperature, and time before returning to work do not appear to be much different from those after CO₂ insufflation.