Does Size Matter? Opioid Use after Laparoscopy for Apical Pelvic Organ Prolapse Using an 8 mm versus 10—12 mm Accessory Port

Abstract

To determine whether a change in lateral accessory port (LAP) size from 10-"?>12 mm to 8 mm among women undergoing laparoscopic native tissue pelvic organ prolapse (POP) surgery was effective at reducing opioid use after surgery. Prospective cohort of women taking part in a POP surgical registry. Tertiary academic hospital in Calgary, Canada. Women undergoing laparoscopic uterosacral ligament apical suspensions for stage ≥2 POP with either uterine preservation or concomitant hysterectomy. A total of 92 women were included during a 15-month study period from June 2020 and September 2021. Laparoscopic apical suspension using either a 10-"?>12 mm or 8 mm LAP, with the change occurring at the midpoint of the study period. Fascial defects from 10-"?>12 mm ports were closed with a fascial closure device. Perioperative care and technique were otherwise unchanged. Postoperative opioiduse was measured by mean morphine equivalent daily dose, accounting for all oral and intravenous opioids used in the first 24 hours after surgery. A total of 50 cases (54.3%) useda 10-12 mm LAP, and 42 cases (45.7%) used an 8 mm LAP. Meanmorphine equivalent daily dose after surgery with a 10-12 mm LAP was significantly higher than with an 8 mm LAP (35.3[95% confidence interval (CI) 24.9-45.6]vs 13.6 [95%CI 8.0-19.2], p <.001). The proportion of women who did not require opioids postoperatively was higher in the 8 mm group(45.2%,n=19)than the 10-12 mm group (18.0%, n=9) (crude odds ratio 3.76, 95% CI 1.47-9.66).Similarly, the proportion of women who did not fill an opioid prescription after discharge was higher in the 8 mm group (35.7%, n=15) than the 10-12 mm group (16.0%, n=8) (crude odds ratio 2.92, 95% CI 1.09-7.81). These resultsremained statistically significantafter adjustment for age, body mass index, race and ethnicity, length of procedure, and concomitant procedures performed. Compared with a 10-12 mm port, the use of an 8 mm LAP during laparoscopic native tissue apical POP surgery is associated with decreased opioid use in the first 24 hours after surgery.