A comparison of postoperative pain after transumbilical single‐port access and conventional three‐port total laparoscopic hysterectomy: a randomized controlled trial

Chung, Jae Hyun; Baek, Jong Min; Chung, Kyudon; Park, Eun Kyung; Jeung, In Cheul; Chang, Hyun; Choi, J.; Kim, Chan Joo; Lee, Young Suk

doi:10.1111/aogs.12767

Cited by 26 publications

(18 citation statements)

References 29 publications

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“…Prior studies have reviewed the proposed benefits of a vNOTES approach including better visualization of pelvic structures compared to traditional vaginal procedures, lower pain scores, and improved cosmesis, owing to the lack of an abdominal incision [8,9]. However, many of these studies have small sample sizes and are limited in their generalizability with data derived from a single institution [26][27][28][29][30][31][32][33]. We sought to systematically review the current literature to compare the safety and efficacy of conventional multiport laparoscopic (MPL) hysterectomy both to LESS and vNOTES approaches to determine if one approach is associated with improved patient outcomes, within a larger, more heterogeneous sample of patients.…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of Laparoendoscopic Single-site and Vaginal Natural Orifice Transluminal Endoscopic Hysterectomy Compared with Multiport Hysterectomy: Real Benefits or Diminishing Returns?

Michener¹,

Lampert

Yao³

et al. 2021

Journal of Minimally Invasive Gynecology

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Section: Introductionmentioning

confidence: 99%

Meta-analysis of Laparoendoscopic Single-site and Vaginal Natural Orifice Transluminal Endoscopic Hysterectomy Compared with Multiport Hysterectomy: Real Benefits or Diminishing Returns?

Michener¹,

Lampert

Yao³

et al. 2021

Journal of Minimally Invasive Gynecology

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“…Studies comparing single-port surgery versus minilaparotomy were mixed, with one study reporting less pain in the single-port group,51 while others finding no difference 52 53. Chung and colleagues54 reported more rescue analgesics in the single-port group when it was compared with a standard three-port surgery while other studies found no difference in pain scores or analgesics 55 56. Compared with single-port hysterectomy, minilaparoscopy led to lower pain scores in one study 57.…”

Section: Resultsmentioning

confidence: 95%

Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations

Lirk

Thiry

Bonnet

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Background and objectivesLaparoscopic hysterectomy is increasingly performed because it is associated with less postoperative pain and earlier recovery as compared with open abdominal hysterectomy. The aim of this systematic review was to evaluate the available literature regarding the management of pain after laparoscopic hysterectomy.Strategy and selection criteriaRandomized controlled trials evaluating postoperative pain after laparoscopic hysterectomy published between January 1996 and May 2018 were retrieved, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, from the EMBASE and MEDLINE databases and the Cochrane Register of Controlled Trials. Efficacy and adverse effects of analgesic techniques were assessed.ResultsOf the 281 studies initially identified, 56 were included. Of these, 31 assessed analgesic or anesthetic interventions and 25 assessed surgical interventions. Acetaminophen, non-steroidal anti-inflammatory drugs, and dexamethasone reduced opioid consumption. Limited evidence hindered recommendations on alpha-2-agonists. Inconsistent evidence was found in the studies investigating pregabalin and transversus abdominis plane block, and no evidence was found for intraperitoneal local anesthetics, port site infiltration, or single-port laparoscopy. Measures to lower peritoneal insufflation pressure or humidify or heat insufflated gas seem to reduce the incidence of shoulder pain, but not abdominal pain.ConclusionsThe baseline analgesic regimen for laparoscopic hysterectomy should include acetaminophen, a non-steroidal anti-inflammatory drug, dexamethasone, and opioids as rescue analgesics.

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“…In addition, it cannot be excluded that enrolled patients in the study are biased with respect to their pain outcomes as, except in one study, the included patients were not blinded to the type of surgery. One single randomized controlled trial applied accurate blinding [20]. Patients and anesthesiology staff who measured the postoperative pain scores did not know which type of approach had been performed, while similar pain scores were found.…”

Section: Discussionmentioning

confidence: 99%

Comparison of laparoscopy-assisted vaginal hysterectomy as endoscopic single-station surgery and conventional laparoscopic hysterectomy—surgical effects on safety and quality of life

et al. 2019

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Background: To extend the benefits of minimally invasive surgery, an increasing enthusiasm has emerged for the laparo-endoscopic single-site surgery (LESS). The idea of LESS is to allow inserting multiple laparoscopic instruments through only one umbilical incision instead of multiple abdominal incisions. Methods: Sixty patients from three different centers in Germany were randomized (1:1) to conventional laparoscopic hysterectomy (n = 31) or LESS hysterectomy (n = 29). The study focused in particular on the safety and efficacy of both techniques. Results: The mean operative time was comparable in both groups (68.2 vs 73.6 min., p = 0.409; 95% CI − 18.69-7.12). No differences were seen regarding estimated blood loss (p = 0.915; 95% CI − 21.02-18.88), intra-and postoperative complications (p = 0.944), and wound infection rates (p = 0.944). Patients within the LESS group experienced significantly less pain in the first 24 h postoperatively (p = 0.006); the pain scores at 3, 5, 7 days and 2 months postoperatively were comparable. Conclusion: LESS hysterectomy is a reliable and safe option in gynecologic surgery. Compared to conventional laparoscopic hysterectomy, LESS surgery demonstrated comparable surgical properties in regard to blood loss, duration of surgery, and intra-/postoperative complications. Notably, patients undergoing LESS hysterectomy experienced some less pain postoperatively.

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A comparison of postoperative pain after transumbilical single‐port access and conventional three‐port total laparoscopic hysterectomy: a randomized controlled trial

Abstract: SPA-TLH was feasible compared with MPA-TLH but the SPA-TLH group had a longer operative time. Although there is no difference in pain based on the visual analog scale pain score, the SPA-TLH group required more analgesia to give the same postoperative pain control.

Cited by 26 publications

References 29 publications

Meta-analysis of Laparoendoscopic Single-site and Vaginal Natural Orifice Transluminal Endoscopic Hysterectomy Compared with Multiport Hysterectomy: Real Benefits or Diminishing Returns?

Meta-analysis of Laparoendoscopic Single-site and Vaginal Natural Orifice Transluminal Endoscopic Hysterectomy Compared with Multiport Hysterectomy: Real Benefits or Diminishing Returns?

Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations

Comparison of laparoscopy-assisted vaginal hysterectomy as endoscopic single-station surgery and conventional laparoscopic hysterectomy—surgical effects on safety and quality of life

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