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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Article info
Publication history
Published online: November 14, 2022
Accepted:
November 11,
2022
Received in revised form:
November 8,
2022
Received:
October 4,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
