Recovery after Low-Impact Laparoscopic Hysterectomy: A Randomized Controlled Clinical Trial.

BACKGROUND Low-impact laparoscopy (LIL), a surgical protocol using mini-laparoscopic instruments and low-and-stable pneumoperitoneal pressure, was developed as a minimally invasive approach to mitigate local and systemic effects of laparoscopy. However, its real clinical impact is still poorly documented. OBJECTIVE To evaluate LIL impact on the postoperative recovery quality 6 hours after laparoscopic hysterectomy (henceforth 6H postsurgery) compared to conventional laparoscopy. STUDY DESIGN Single-center, double-blinded, randomized controlled trial, conducted between December 2019 and August 2023, evaluating different approaches for outpatient laparoscopic hysterectomies. Sixty-eight adult patients scheduled for outpatient laparoscopic hysterectomy were included and randomized into 2 groups: LIL with mini-trocars and low peritoneal pressure or conventional laparoscopy with standard-size trocars and higher peritoneal insufflation pressure. The primary outcome was recovery quality 6H postsurgery, assessed with the multidimensional Postoperative Quality of Recovery Scale (PQRS). Secondary outcomes were: Analgesia Nociception Index-guided intraoperative remifentanil administration, intraoperative pain stimulation, postoperative pain intensity, opioid use, surgeon-assessed surgical conditions, adverse events, time to discharge and patient satisfaction. RESULTS Two homogeneous groups were obtained. Protocol deviations attributable to surgical difficulties requiring larger instruments and higher pneumoperitoneal pressures to complete the intervention occurred in 6 LIL-group patients. Recovery quality 6H postsurgery was comparable for the LIL and conventional groups (respectively, 10/34 (29%) and 8/34 (24%) of patients recovered their preoperative PQRS values, p=0.58). The LIL group had lower intraoperative pain stimulation, with less remifentanil consumption. Postoperative pain intensity at rest and coughing, and morphine-requirement, adverse event, same-day-discharge and patient-satisfaction rates did not differ between the 2 groups. Surgical conditions were deemed poorer in the LIL group. CONCLUSION Despite slightly less intraoperative pain stimulation, attesting to its minimally invasive nature, LIL did not appear to improve 6H-postsurgery recovery compared to conventional laparoscopy. Surgical conditions were rated poorer for the LIL group. LIL does not seem to provide any clinical benefit.