Pain With Differing Insufflation Pressures During Robotic Sacrocolpopexy: A Randomized Controlled Trial

Area of Science:

• Urogynecology
• Minimally Invasive Surgery
• Surgical Outcomes

Background:

• Robotic-assisted sacrocolpopexy is a common procedure for pelvic organ prolapse.
• Elevated intra-abdominal pressure during robotic surgery may contribute to postoperative pain.
• Optimizing insufflation pressure is crucial for patient comfort and recovery.

Purpose of the Study:

• To determine if reducing insufflation pressure decreases postoperative pain and opioid requirements in women undergoing robotic-assisted sacrocolpopexy.
• To compare pain scores and opioid use between a lower (12 mm Hg) and standard (15 mm Hg) insufflation pressure group.

Main Methods:

• A single-blinded randomized trial involving women with pelvic organ prolapse.
• Participants were assigned to robotic-assisted sacrocolpopexy at either 12 mm Hg or 15 mm Hg insufflation pressure.
• Primary outcome: pain visual analog scale (VAS) on postoperative day 1; secondary outcomes: outpatient pain, opioid use, operative time, blood loss.

Main Results:

• The lower insufflation pressure group (12 mm Hg) reported significantly less pain on postoperative day 1 (median VAS 17.0 mm vs. 29.0 mm, P=.007).
• Fewer opioids were used by the lower pressure group during inpatient and outpatient recovery (P=.04 and P=.02, respectively).
• No significant differences were observed in operative time, estimated blood loss, or length of stay.

Conclusions:

• Lowering insufflation pressure to 12 mm Hg during robotic-assisted sacrocolpopexy is a safe and effective method to reduce postoperative pain.
• This approach also leads to decreased opioid consumption, improving patient recovery.
• The findings support the use of reduced insufflation pressure as a standard of care in this procedure.