LAS VEGAS – Patients experience less right-sided pain after laparoscopic sacrocolpopexy when surgeons use an 8-mm assistant port instead of a 12-mm port, results from a small trial show.
M. Alexander Otto/MDedge News
Dr. Yufan Brandon Chen
In the trial, conducted at Loyola University Medical Center in Maywood, Ill.,17 women were randomized to undergo the procedure with an 8-mm assistant port, and 18 with a 12-mm port, both on the right side of the abdomen.
Overall, pain severity was low at 2 weeks postop in both groups at just over 1 point on a 10-point visual analogue scale and not statistically different. However, patients who had a 12-mm assistant port were more likely to report right-sided pain, compared with those who had an 8-mm assistant port (60% vs.18%, P = 0.027).
“I saw a lot of these patients in the clinic at 2 weeks, and even though the overall pain score was low, they kept complaining about a dull, achy pain on the right side. They were using ibuprofen, and some of them had even restricted [their activities] because they were afraid they were going to pop a stitch,” said study lead Yufan B. Chen, MD, a urogynecology fellow at Loyola.
He said the research team thinks the difference in port-site pain “is clinically significant. . Since our study ended, we have stopped using the 12-mm port in most of our cases; we use the 8-mm port for the assistant,” he said at the meeting, sponsored by the American Association of Gynecologic Laparoscopists.
The tradeoff was that there were more needle struggles with the 8-mm port, 3.1/case vs. 0.6/case (P = .004). Surgeons found inserting and withdrawing the Gore-Tex needle through the smaller port more difficult. But there were no needle losses in either group and no differences in operative time – an average of about 95 minutes.
“The larger port size essentially benefits the surgeon more than the patient. This is kind of a common theme in minimally invasive surgery where less is actually more,” he said. Since the study, “we have identified why we have challenges with the needle transport; it’s usually because the needle gets bent, so we just unbend it a little bit with our needle drivers before we remove it,” Dr. Chen said.
Even so, “there may be a role in using the 12-mm port when you have assistants who are not [that] experienced,” he said.
Laparoscopic sacrocolpopexy is done through four ports at Loyola: a 12-mm umbilical port for the scope; two 5-mm ports on the left for the primary surgeon; and the right side port for the assistant, through which the Gore-Tex needle is passed.
In the study, there were no demographic or preop differences between the two groups of women. About 60% were white, with a mean age of 61 years. About 10% of the women had had prior abdominal surgery.
The study received no industry funding, and the investigators had no disclosures.
aotto@mdedge.com
SOURCE: Chen YB et al. 2018 AAGL Global Congress, Abstract 197.