Umbilical Morcellation and Postoperative Pain in Patients Undergoing Benign Hysterectomy

Morcellation has allowed patients with enlarged uteri to obtain a minimally invasive hysterectomy with improved outcomes; however, there is little information regarding postoperative pain. Our study aims to compare pain scores and opioid requirements in patients undergoing umbilical morcellation during benign minimally invasive hysterectomy versus those who do not require morcellation.

A retrospective cohort study was performed at a tertiary care center including patients who underwent total laparoscopic or supracervical hysterectomy by one high volume surgeon from 2019 to 2022. Baseline characteristics, postoperative pain scores, and morphine milligram equivalents in the acute and late setting were recorded. Two-sample t test for continuous variables and χ² or Fisher's exact test for categorical variables were used to compare differences. A multiple regression model evaluated the effect of groups with the adjustment of confounders.

A total of 232 patients underwent hysterectomy in which 57 underwent umbilical manual morcellation and 175 did not. There was no difference in postoperative complications, readmissions, or blood products required (P > 0.05). Individuals that underwent umbilical morcellation had longer operative times (226.6 vs 120.1 minutes, P < 0.01), more blood loss (311.1 vs 82.0 mL, P < 0.01), longer length of stay (0.60 vs 0.44 days, P < 0.01), increased uterine weight (1,293.2 vs 151.6 g, P < 0.01), and fibroid pathology (93.0% vs 46.3%, P < 0.01). There were no differences in postoperative pain scores, immediate and later opioid use between groups on multivariate analysis.

Patients who undergo umbilical morcellation, typically for large fibroid uteri, have similar postoperative pain scores, opioid use, and postoperative complications to those who undergo hysterectomy for other indications.