Abstract
Background
Transvaginal cholecystectomy (TVC) is the most common natural orifice transluminal surgery (NOTES) performed in women, yet there is a paucity of data on intraoperative and immediate postoperative pain management. Previous studies have demonstrated that NOTES procedures are associated with less postoperative pain and faster recovery times. This study analyzes intraoperative and postoperative opioid use for TVC compared with traditional four-port laparoscopic cholecystectomies (LCs).
Methods
This is a retrospective analysis of consecutive TVC and LC female patients between August 2009 and August 2012 in an academic institution. We compared demographics, intraoperative and postoperative opioid use and times in the operating room (OR) and in the post anesthesia care unit (PACU).
Results
A total of 68 TVC and 67 LC patients were included in this study. The TVC and LC groups were similar in terms of age (both 41 years) and body mass index (29 and 31 kg/m2, respectively). The intraoperative preparation, surgical, and emergence times were significantly longer for the TVC than for the LC (p ≤ 0.01). Compared with the LC group, the intraoperative opioid requirement was significantly greater (TVC 27 mg vs. LC 25 mg; p = 0.003), but after adjusting for anesthesia time, the difference in OR opioid consumption became non-significant (p = 0.08). The PACU opioid requirement (TVC 2.5 vs. LC 5 mg; p = 0.04) was significantly lower for the TVC group, and a greater proportion of patients did not need any pain medications (TVC 38 % vs. LC 21 %; p = 0.04), compared with the LC group. The average PACU pain scores were not significantly different between the groups (p = 0.45).
Conclusion
TVC patients did not experience more pain than LC patients. Although the average pain scores of TVC patients did not differ from those of the LC patients, TVC patients did require less pain medication in the PACU.
Similar content being viewed by others
References
Reynolds W Jr (2001) The first laparoscopic cholecystectomy. JSLS 5:89–94
Zorrón R, Filgueiras M, Maggioni LC, Pombo L, Lopes Carvalho G, Lacerda Oliveira A (2007) NOTES. Transvaginal cholecystectomy: report of the first case. Surg Innov 14:279–283
Zornig C, Emmermann A, von Waldenfels HA, Mofid H (2007) Laparoscopic cholecystectomy without visible scar: combined transvaginal and transumbilical approach. Endoscopy 39:913–915
Marescaux J, Dallemagne B, Perretta S, Wattiez A, Mutter D, Coumaros D (2007) Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg 142:823–826; discussion 826–827
Solomon D, Shariff AH, Silasi DA, Duffy AJ, Bell RL, Roberts KE (2012) Transvaginal cholecystectomy versus single-incision laparoscopic cholecystectomy versus four-port laparoscopic cholecystectomy: a prospective cohort study. Surg Endosc 26:2823–2827
Auyang ED, Santos BF, Enter DH, Hungness ES, Soper NJ (2011) Natural orifice translumenal endoscopic surgery (NOTES®): a technical review. Surg Endosc 25:3135–3148
Lehmann KS, Ritz JP, Wibmer A, Gellert K, Zornig C, Burghardt J, Busing M, Runkel N, Kohlhaw K, Albrecht R, Kirchner TG, Arlt G, Mall JW, Butters M, Bulian DR, Bretschneider J, Holmer C, Buhr HJ (2010) The German registry for natural orifice translumenal endoscopic surgery: report of the first 551 patients. Ann Surg 252:263–270
Zorron R, Palanivelu C, Galvao Neto MP, Ramos A, Salinas G, Burghardt J, DeCarli L, Henrique Sousa L, Forgione A, Pugliese R, Branco AJ, Balashanmugan TS, Boza C, Corcione F, D’Avila Avila F, Arturo Gomez N, Galvao Ribeiro PA, Martins S, Filgueiras M, Gellert K, Wood Branco A, Kondo W, Inacio Sanseverino J, de Sousa JA, Saavedra L, Ramirez E, Campos J, Sivakumar K, Rajan PS, Jategaonkar PA, Ranagrajan M, Parthasarathi R, Senthilnathan P, Prasad M, Cuccurullo D, Muller V (2010) International multicenter trial on clinical natural orifice surgery—NOTES IMTN study: preliminary results of 362 patients. Surg Innov 17:142–158
Dahan A, Aarts L, Smith TW (2010) Incidence, reversal, and prevention of opioid-induced respiratory depression. Anesthesiology 112:226–238
Barletta JF (2012) Clinical and economic burden of opioid use for postsurgical pain: focus on ventilatory impairment and ileus. Pharmacotherapy 32:12S–18S
Roberts KE, Shetty S, Shariff AH, Silasi DA, Duffy AJ, Bell RL (2012) Transvaginal NOTES hybrid cholecystectomy. Surg Innov 19:230–235
Zornig C, Siemssen L, Emmermann A, Alm M, von Waldenfels HA, Felixmuller C, Mofid H (2011) NOTES cholecystectomy: matched-pair analysis comparing the transvaginal hybrid and conventional laparoscopic techniques in a series of 216 patients. Surg Endosc 25:1822–1826
Kilian M, Raue W, Menenakos C, Wassersleben B, Hartmann J (2011) Transvaginal-hybrid vs. single-port-access vs. ‘conventional’ laparoscopic cholecystectomy: a prospective observational study. Langenbecks Arch Surg 396:709–715
Borchert D, Federlein M, Ruckbeil O, Burghardt J, Fritze F, Gellert K (2012) Prospective evaluation of transvaginal assisted cholecystectomy. Surg Endosc 26:3597–3604
Federlein M, Borchert D, Muller V, Atas Y, Fritze F, Burghardt J, Elling D, Gellert K (2010) Transvaginal video-assisted cholecystectomy in clinical practice. Surg Endosc 24:2444–2452
Zorron R, Maggioni LC, Pombo L, Oliveira AL, Carvalho GL, Filgueiras M (2008) NOTES transvaginal cholecystectomy: preliminary clinical application. Surg Endosc 22:542–547
Santos BF, Teitelbaum EN, Arafat FO, Milad MP, Soper NJ, Hungness ES (2012) Comparison of short-term outcomes between transvaginal hybrid NOTES cholecystectomy and laparoscopic cholecystectomy. Surg Endosc 26:3058–3066
Acknowledgments
This publication was made possible by CTSA Grant Number UL1 RR024139, from the National Center for Research Resources (NCRR) and the National Center for Advancing Translational Science (NCATS), components of the National Institutes of Health (NIH), and NIH roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.
Disclosures
Authors Stephanie G. Wood, Susan Dabu-Bondoc, Feng Dai, Hosni Mikhael, and Nalini Vadivelu have no conflicts of interest or financial ties to disclose. Dr. Kurt E. Roberts provided consultancy services for Covidien, participated in a Covidien-Sponsored Grant, and has a patent pending with NovaTract.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wood, S.G., Dabu-Bondoc, S., Dai, F. et al. Comparison of immediate postoperative pain after transvaginal versus traditional laparoscopic cholecystectomy. Surg Endosc 28, 1141–1145 (2014). https://doi.org/10.1007/s00464-013-3294-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-013-3294-8