Recovery after low-impact laparoscopic hysterectomy: a randomized controlled clinical trial

Low-impact laparoscopy, 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.

To evaluate low-impact laparoscopy impact on the postoperative recovery quality 6 hours after laparoscopic hysterectomy compared to conventional laparoscopy.

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: low-impact laparoscopy with mini-trocars and low peritoneal pressure or conventional laparoscopy with standard-sized trocars and higher peritoneal insufflation pressure. The primary outcome was recovery quality 6 hours after laparoscopic hysterectomy, assessed with the multidimensional Postoperative Quality of Recovery Scale. 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.

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 low-impact laparoscopy-group patients. Recovery quality 6 hours after laparoscopic hysterectomy was comparable for the low-impact laparoscopy and conventional groups (10/34 [29%] and 8/34 [24%] of patients recovered their preoperative Postoperative Quality of Recovery Scale values, respectively; P=.58). The low-impact laparoscopy 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 low-impact laparoscopy group.

Despite slightly less intraoperative pain stimulation, attesting to its minimally invasive nature, low-impact laparoscopy did not appear to improve 6 hours after laparoscopic hysterectomy recovery compared to conventional laparoscopy. Surgical conditions were rated poorer for the low-impact laparoscopy group. Low-impact laparoscopy does not seem to provide any clinical benefit.