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

Abstract

Study Objective

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

Design

Prospective cohort study.

Setting

Academic hospital.

Patients or Participants

Women undergoing surgery with anticipated manual morcellation for tissue extraction by minimally invasive gynecologists between October 2022 and February 2024. Sixty-four patients were enrolled, thirteen were excluded, twenty-seven were included in the suprapubic site morcellation group and twenty-three in the umbilical site 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. Patient pain perception at 24 hours and 2 weeks post-operatively was obtained through a survey with a ten-point visual analog pain scale. Number of narcotics was recorded.

Measurements and Main Results

The difference in worst pain score at 24 hours and 2 weeks post-operatively was not statistically significant between groups. Mean worst pain scores at 24 hours post-operative were 7.37 ± 2.42 and 7.3 ±1.74 for the suprapubic and umbilical group respectively (p=0.528). Mean worst pain scores 2 weeks post-operative were 5.78 ± 2.83 and 4.87 ± 2.47 for the suprapubic and umbilical group respectively (p=0.244). The number of post-operative narcotics used at 24 hours was not statistically different, but at 2 weeks was 4.8 ± 4.5 and 2.3 ± 2.6 in the suprapubic and umbilical group respectively (p=0.037) and was statistically different. Mean patient satisfaction with post-operative pain was not different between groups. There were no statistical differences in length of hospital stay, post-operative complications, or post-operative hernia.

Conclusion

Our study demonstrates that there was no difference in patient reported post-operative pain between extension of the umbilical versus the suprapubic port site, but there was a statistical difference in narcotic usage with umbilical morcellation being associated with less narcotic requirement 2 weeks after surgery.