This preprint is under consideration at Gynecological Surgery. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
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Original Article
Pattaya Hengrasmee
Mahidol University Faculty of Medicine Siriraj Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-4820-960X
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: One of the major drawbacks of gynecologic laparoscopy is post-laparoscopic shoulder pain (PLSP) that is believed to result from intra-abdominal CO2 retention leading to peritoneal and diaphragmatic stretching and causing referred pain in C4 dermatome. Several interventions have been applied to prevent and reduce its incidence and severity, with contradictory results. Only pulmonary recruitment maneuver, extended assisted ventilation and active intra-abdominal gas aspiration have been mentioned to be effective interventions for CO2 evacuation. However, in our experience, an alternative technique of delayed suprapubic port removal (DSPR) was found to be an effective method in CO2 expulsion. Therefore, we conducted this randomized trial to determine the effectiveness of the DSPR technique in reducing the incidence and severity of PLSP. The trial was conducted at a single, tertiary hospital between May 2015 and May 2016. Having complied with the criteria, 220 patients scheduled for elective gynecological laparoscopy were randomly allocated into 2 groups after giving informed consent. Laparoscopic procedures were performed through 10-mm umbilical port and at least 2 ancillary, including suprapubic, ports. In conventional group, ancillary ports were removed at the end of surgery leaving only opened umbilical cannula for pneumoperitoneum deflation. Abdominal compression from periphery towards umbilicus was performed to further expel CO2 before removing the umbilical cannula. In DSPR group, both umbilical and suprapubic cannulas were retained. Two-step abdominal compression was undertaken, primarily towards umbilicus and secondarily towards pelvic cavity, before sequentially removing the umbilical and the suprapubic cannulas. Postoperatively, each patient was asked to rate PLSP level on 100–mm VAS during 0-6, 6-12, 12-24, and 24-48 hours respectively. Statistical analysis was performed to determine both incidence and severity of PLSP during 24- and 48-hours post-laparoscopy.
Results: Patients in DSPR group demonstrated significantly lower incidence of PLSP within 24 hours (43.8% vs 59.0%; p=0.027) and 48 hours (43.8% vs 60.0%; p=0.019), and expressed apparently lower pain scores (0(0-0) vs 0(0-8); p=0.020) during 24-48 hours post-surgery.
Conclusion: DSPR is an effective CO2 expulsion technique, resulting in significant reduction of both incidence and severity of PLSP within 24-48 hours post-laparoscopy.
Trial registration: Thai Clinical Trials Registry; TCTR20160208003; Registered 8 February 2016 - Retrospectively registered; http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=1715
Keywords
delayed suprapubic port removal, post-laparoscopic shoulder pain, incidence, severity
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CURRENT STATUS: Under Review
Version 1
Posted 11 Jan, 2021
No community comments so far
Editorial decision: Minor revision
On 09 Feb, 2021
Review #2 received
Received 08 Feb, 2021
Review #1 received
Received 04 Feb, 2021
Reviewer #2 agreed
On 30 Jan, 2021
Reviewers invited
Invitations sent on 30 Jan, 2021
Reviewer #1 agreed
On 30 Jan, 2021
Editor assigned
On 06 Jan, 2021
Submission checks complete
On 06 Jan, 2021
Editor invited
On 06 Jan, 2021
First submitted
On 23 Dec, 2020
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Subject Areas
Surgical Obstetrics & Gynecology
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This preprint is under consideration at Gynecological Surgery. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Original Article
Pattaya Hengrasmee
Mahidol University Faculty of Medicine Siriraj Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-4820-960X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 11 Jan, 2021
No community comments so far
Editorial decision: Minor revision
On 09 Feb, 2021
Review #2 received
Received 08 Feb, 2021
Review #1 received
Received 04 Feb, 2021
Reviewer #2 agreed
On 30 Jan, 2021
Reviewers invited
Invitations sent on 30 Jan, 2021
Reviewer #1 agreed
On 30 Jan, 2021
Editor assigned
On 06 Jan, 2021
Submission checks complete
On 06 Jan, 2021
Editor invited
On 06 Jan, 2021
First submitted
On 23 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Surgical Obstetrics & Gynecology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: One of the major drawbacks of gynecologic laparoscopy is post-laparoscopic shoulder pain (PLSP) that is believed to result from intra-abdominal CO2 retention leading to peritoneal and diaphragmatic stretching and causing referred pain in C4 dermatome. Several interventions have been applied to prevent and reduce its incidence and severity, with contradictory results. Only pulmonary recruitment maneuver, extended assisted ventilation and active intra-abdominal gas aspiration have been mentioned to be effective interventions for CO2 evacuation. However, in our experience, an alternative technique of delayed suprapubic port removal (DSPR) was found to be an effective method in CO2 expulsion. Therefore, we conducted this randomized trial to determine the effectiveness of the DSPR technique in reducing the incidence and severity of PLSP. The trial was conducted at a single, tertiary hospital between May 2015 and May 2016. Having complied with the criteria, 220 patients scheduled for elective gynecological laparoscopy were randomly allocated into 2 groups after giving informed consent. Laparoscopic procedures were performed through 10-mm umbilical port and at least 2 ancillary, including suprapubic, ports. In conventional group, ancillary ports were removed at the end of surgery leaving only opened umbilical cannula for pneumoperitoneum deflation. Abdominal compression from periphery towards umbilicus was performed to further expel CO2 before removing the umbilical cannula. In DSPR group, both umbilical and suprapubic cannulas were retained. Two-step abdominal compression was undertaken, primarily towards umbilicus and secondarily towards pelvic cavity, before sequentially removing the umbilical and the suprapubic cannulas. Postoperatively, each patient was asked to rate PLSP level on 100–mm VAS during 0-6, 6-12, 12-24, and 24-48 hours respectively. Statistical analysis was performed to determine both incidence and severity of PLSP during 24- and 48-hours post-laparoscopy.
Results: Patients in DSPR group demonstrated significantly lower incidence of PLSP within 24 hours (43.8% vs 59.0%; p=0.027) and 48 hours (43.8% vs 60.0%; p=0.019), and expressed apparently lower pain scores (0(0-0) vs 0(0-8); p=0.020) during 24-48 hours post-surgery.
Conclusion: DSPR is an effective CO2 expulsion technique, resulting in significant reduction of both incidence and severity of PLSP within 24-48 hours post-laparoscopy.
Trial registration: Thai Clinical Trials Registry; TCTR20160208003; Registered 8 February 2016 - Retrospectively registered; http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=1715
Figure 1
Figure 2
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