Effect of Location of Minilaparotomy for Morcellation at the Time of Myomectomy and Hysterectomy on Postoperative Pain.

STUDY

OBJECTIVE

To compare patient pain perception with extension of the umbilical vs suprapubic laparoscopic port site at the time of tissue morcellation.

DESIGN

Prospective nonrandomized pilot study.

SETTING

Academic hospital.

PARTICIPANTS

Women undergoing surgery with anticipated manual morcellation for tissue extraction. Sixty-four patients were enrolled, 14 were excluded, 27 were included in the suprapubic morcellation group, and 23 in the umbilical morcellation group.

INTERVENTIONS: Patients were assigned to suprapubic or umbilical port site extension for morcellation based on surgeon preference, specimen size and location, and patient characteristics. Pain perception was obtained through a survey with a 10-point pain scale.

MEASUREMENTS AND MAIN

RESULTS

The worst pain scores at 24 hours postoperatively did not significantly differ between groups (suprapubic vs umbilical: 7.4 ± 2.4 vs 7.3 ±1.7, p = .528). The difference increased at 2 weeks postoperatively (5.8 ± 2.8 vs 4.9 ± 2.5, p = .244). Opioid use at 2 weeks, measured as morphine milligram equivalents, was higher in the suprapubic group than the umbilical (36.3 ± 33.5 vs 17.3 ± 19.8, p = .037), but the difference was not statistically significant after covariate adjustment. Satisfaction scores were high in both groups (suprapubic vs umbilical: 4.4 ± 0.8 vs 4.7 ± 0.7, p = .321). There were no statistical differences in length of hospital stay, postoperative complications, and postoperative hernia.

CONCLUSION

In this pilot study, we observed no clear differences in patient-reported postoperative pain at 24 hours or 2 weeks between umbilical and suprapubic port extension for specimen morcellation. Although pain scores tended to be higher in the suprapubic group and morphine milligram equivalent lower with umbilical morcellation at 2 weeks, these differences were not statistically significant after multivariable adjustment.