Laparoscopic surgery offers significant advantages over open procedures, but CO₂ pneumoperitoneum induces physiological changes that impact hemodynamic and respiratory functions. While standard practice uses 12–15 mmHg, low-pressure pneumoperitoneum (8–12 mmHg) is increasingly studied to improve patient safety. Objective: This study evaluates the clinical significance of real-time intra-abdominal pressure (IAP) monitoring, identifies optimal pressure levels, and analyzes its cardiopulmonary effects. Materials and Methods: A systematic review and meta-analysis of 20 high-quality studies (2020–2025) from PubMed, Scopus, Web of Science, and Cochrane Library were conducted using Review Manager (RevMan). Low-pressure (8–12 mmHg) and standard/high-pressure groups were compared. Results & Discussion: An IAP of 10–12 mmHg was found optimal, balancing adequate surgical visualization with respiratory and hemodynamic stability. Pressures 14–15 mmHg significantly reduced cardiac output and lung compliance while increasing systemic vascular resistance and airway pressure. Low-pressure cohorts exhibited stable vitals, less postoperative pain, lower analgesic requirements, and faster recovery. These physiological changes require individualized IAP titration based on patient comorbidities, avoiding a universal approach. Conclusion & Recommendations: Real-time IAP monitoring is vital for patient safety. Maintaining the lowest effective pressure (ideally 10–12 mmHg) is recommended, alongside comprehensive monitoring of vitals and capnography, particularly in high-risk patients.