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Impact of pneumoperitoneum pressure during laparoscopic hysterectomy: A randomized controlled trial

  • Rachael B Smith
    Correspondence
    Corresponding author at: Department of Obstetrics and Gynecology University of Arizona College of Medicine – Phoenix, Banner University Medical Center – Phoenix, 1111 East McDowell Road, Phoenix, AZ 85006.
    Affiliations
    Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery University of Arizona College of Medicine – Phoenix, Banner University Medical Center – Phoenix, 1111 East McDowell Road, Phoenix, AZ 85006, USA
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  • Emily Biller
    Affiliations
    Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery University of Arizona College of Medicine – Phoenix, Banner University Medical Center – Phoenix, 1111 East McDowell Road, Phoenix, AZ 85006, USA
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  • Chengcheng Hu
    Affiliations
    Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724, USA
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  • Nichole D Mahnert
    Affiliations
    Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery University of Arizona College of Medicine – Phoenix, Banner University Medical Center – Phoenix, 1111 East McDowell Road, Phoenix, AZ 85006, USA
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  • Ashley S Womack
    Affiliations
    Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery University of Arizona College of Medicine – Phoenix, Banner University Medical Center – Phoenix, 1111 East McDowell Road, Phoenix, AZ 85006, USA
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  • Sheena Galhotra
    Affiliations
    Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery University of Arizona College of Medicine – Phoenix, Banner University Medical Center – Phoenix, 1111 East McDowell Road, Phoenix, AZ 85006, USA
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  • Jamal Mourad
    Affiliations
    Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery University of Arizona College of Medicine – Phoenix, Banner University Medical Center – Phoenix, 1111 East McDowell Road, Phoenix, AZ 85006, USA
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Published:November 14, 2022DOI:https://doi.org/10.1016/j.ejogrb.2022.11.011

      Abstract

      Objective

      Minimally invasive hysterectomy is a commonly performed gynecologic procedure with associated postoperative pain managed with opioid medications. Uncontrolled postoperative pain leads to increased opioid use/abuse, longer hospital stays, increase in healthcare visits, and may negatively affect patient satisfaction. Current data suggests that reduced pneumoperitoneum insufflation pressure during laparoscopic surgery may impact postoperative pain. Given the current opioid epidemic, surgeons are proactively finding ways to reduce postoperative pain. It is unclear how reduced pneumoperitoneum pressure impacts the surgeon. We investigated the impact of reduced pneumoperitoneum insufflation pressure on surgeon satisfaction.

      Study design

      This was a pilot, double-blinded, randomized controlled trial from March 2020 to July 2021 comparing pneumoperitoneum pressure of 15 mmHg to reduced pressures of 12 mmHg and 10 mmHg during laparoscopic hysterectomy.

      Results

      A total of 40 patients were randomized (13 – 15 mmHg, 13 – 12 mmHg, and 14 – 10 mmHg). The primary outcome was surgeon satisfaction. Secondary outcomes included patient satisfaction, operative time, blood loss, postoperative pain, opioid usage, and discharge timing. There were no differences in baseline demographics or perioperative characteristics. Surgeon satisfaction was negatively impacted with lower pneumoperitoneum pressures greatest with 10 mmHg, including overall satisfaction (p =.01), overall effect of the pneumoperitoneum (p =.04), and quality of visualization (p =.01). There was an apparent although not statistically significant difference in operative time (p =.06) and blood loss (p =.054). There was no difference in patient satisfaction, postoperative pain scores, opioid usage, or time to discharge.

      Conclusion(s)

      Reduced pneumoperitoneum insufflation pressure during laparoscopic hysterectomy negatively impacted surgeon satisfaction with a trend towards longer operative times and greater blood loss, and did not positively impact patient satisfaction, postoperative pain, opioid demand, or discharge timing.

      Keywords

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