Laparoscopic Gynecologic Surgery Research Articles

Effectiveness and Safety of Low-flow Sevoflurane Combined with Remifentanil on Anaesthesia of Patients Undergoing Gynaecological Laparoscopic Surgery

Objective: To evaluate the advantages of sevoflurane (low-flow) + remifentanil for patients undergoing gynaecological laparoscopic surgery. Methods: 300 patients admitted for gynaecological laparoscopic surgery between July 2020 and July 2023 were selected and divided equally by random number table, 150 cases were counted in the observation group, and sevoflurane (low-flow) + remifentanil was chosen for maintenance anaesthesia; 150 cases were counted in the reference group, and anaesthesia was maintained only with remifentanil. The anaesthesia indexes, haemodynamics, stress reaction indexes, and adverse reaction rate of the two groups were compared. Results: The anaesthesia indexes of the observation group were better than those of the reference group (P < 0.05). Before 5 min of anaesthesia (T1), there was no difference between the haemodynamics and stress reaction indexes of the two groups (P > 0.05). After 30 min of pneumoperitoneum (T2) and immediately after the end of surgery (T3), the hemodynamic and stress indicators of the observation group were lower than those of the reference group (P < 0.05). The adverse reaction rate of the observation group was lower than that of the reference group (P < 0.05). Conclusion: Sevoflurane (low-flow) + remifentanil can improve the anaesthesia indexes of gynecological laparoscopic surgery patients, stabilize intraoperative haemodynamics, reduce the stress reaction, and the safety of medication is high.

Remimazolam Reduces Vasopressor Use Post-Induction and During Maintenance of General Anesthesia in Patients Undergoing Laparoscopic Gynecology: A Propensity Score-Matched Analysis.

Objectives: Laparoscopic gynecological surgeries are commonly performed under general anesthesia and can induce cardiovascular depression and hypotension, requiring vasopressor support. Remimazolam, a novel ultra-short-acting benzodiazepine, is used to treat minimal cardiovascular depression. This study compared the hemodynamic effects of remimazolam and sevoflurane anesthesia in patients undergoing laparoscopic gynecological surgery. Methods: A retrospective analysis was conducted on 474 patients who underwent laparoscopic gynecological surgery at Korea University Anam Hospital between September 2021 and December 2022. The patients were categorized into two groups based on the anesthetic agent used: remimazolam or sevoflurane. Hemodynamic parameters, vasopressor use, and intraoperative variables were compared between anesthetic agents. Propensity score matching was applied to account for potential confounders, and logistic regression was utilized to assess the relationship between anesthesia type and outcomes. Results: Remimazolam anesthesia was linked to a significantly lower incidence of vasopressor use compared to sevoflurane-based anesthesia (3.7% vs. 19.5%, p < 0.0001). The odds of requiring vasopressor support were significantly lower during the post-induction and maintenance phases in the remimazolam group. Furthermore, hemodynamic stability, particularly systolic and mean arterial pressures, was better maintained with remimazolam than sevoflurane. Conclusions: Remimazolam provides superior hemodynamic stability and reduces the need for vasopressor support during laparoscopic gynecological surgery compared with sevoflurane.

Endotracheal Tube Cuff Deflation Methods Reduce Stress Response and Incidence of Postoperative Pharyngeal Complications in Patients Treated with Gynecological Laparoscopic Surgery.

This study aims to explore the impact of endotracheal tube cuff deflation methods on extubation stress responses and postoperative pharyngeal complications in patients treated with gynecological laparoscopic surgery. In this study, retrospective clinical data of 94 patients treated with gynecological laparoscopic surgery under general anesthesia in Northwest Women's and Children's Hospital from June 2023 to June 2024 were collected and analyzed. Patients were assigned into two groups based on the cuff deflation methods used after anesthesia: Group A (45 patients) adopted a one-time deflation method, while Group B (49 patients) employed a gradual deflation method. Surgery-associated indicators were recorded, with heart rate (HR), mean arterial pressure (MAP), rate pressure product (RPP), epinephrine (E), norepinephrine (NE), and cortisol (Cor) levels monitored at selected time points: before cuff (T0), immediately after extubation (T1), 1 minute post-extubation (T2), 5 minutes post-extubation (T3), and 10 minutes post-extubation (T4). The incidence of pharyngeal complications was also compared between the two groups. Compared with Group A, Group B displayed smaller variations in HR, MAP, and RPP at T1, T2, and T3 (p < 0.05). Group B also showed smaller variations in E, NE, and Cor levels at T2, T3, and T4 in contrast with Group A (p < 0.05). The incidence of complications such as coughing, sore throat, and hoarseness was conspicuously attenuated in Group B compared to Group A (6.12% vs 22.22%, p < 0.05). Gradual deflation of the endotracheal tube cuff dramatically ameliorates extubation stress responses, stabilizes hemodynamics, and alleviates pharyngeal discomfort in patients treated with gynecological laparoscopic surgery.

Variants for dosing of rocuronium taken into obesity during general anesthesia in gynecological laparoscopic surgery

The objective was to identify the optimal method of dosing the muscle relaxant rocuronium during gynecological laparoscopic surgery in obese patients.Materials and methods. The study included 36 women with obesity II–III degree, which performed elective gynecological laparoscopic surgery. They were divided into 3 groups. In group 1, rocuronium were dosed at the rate of 0.6 mg/kg of ideal body weight calculated by the Lorentz formula. In group 2, rocuronium were dosed at the rate of 0.6 mg/kg of actual body weight. In group 3, rocuronium were dosed at the rate of 22.5 mg/m2 of body surface area. The comparison group (group 0) included 20 patients with body mass index equal to 18.5–25 kg/m2.Results. The shortest time for the onset of deep neuromuscular block was noted in groups 2 and 3, and the longest, comparable to the indicator in group 0, was in group 1 (p &lt; 0.05). The time from rocuronium administration to the onset of restoration of neuromuscular conduction was the shortest in group 1: 22 [20; 25] minutes, and the longest in group 2: 40 [35; 45] min. There was no statistically significant difference in the dosing of rocuronium in obese patients at body surface area in group 3 compared with dosing for actual weight in group 0: 27 [22; 29] and 27 [25; 33] min, respectively. The recovery time of neuromuscular conduction from TOF = 1 to TOF = 25% was the shortest in group 1 (23 [18; 24] min) and was significantly different from the value in groups 2 and 3, as well as in patients of group 0. In groups 0, 2, 3, values of this indicator were identical. The recovery index did not differ significantly in all four groups.Conclusion. Dosing rocuronium in obese patients based on body surface area has an advantage for comparison over dosing based on both actual and ideal body weight, resulting in greater predictability of neuromuscular block dynamics.

Low-pressure Pulmonary Recruitment Maneuver to Decrease Post-laparoscopic Shoulder Pain in Gynecologic Surgery: A Double-blind Randomized Placebo Controlled Trial

Objective: To evaluate the efficacy of minimum optimal pressure (30 and 40 cmH2 O) of pulmonary recruitment maneuver (PRM) for reducing post-laparoscopic shoulder pain (PLSP). Methods: Women who were scheduled for laparoscopic gynecologic surgery during October 2020 to June 2021 were enrolled and randomly assigned to three groups: PRM 30 cmH2 O (30-PRM) group, PRM 40 cmH2 O (40-PRM) group and control group. All participants were placed in the Trendelenburg position and compressed abdomen to eradicate gas. PLSP scores were assessed by using a visual analog scale (VAS). Results: Total of 80 women were included and randomized to 30-PRM group (N = 28), 40-PRM group (N = 26) and control group (N = 26).The PLSP scores at 12-hour after surgery in 40-PRM group were significantly lower than the control group (VAS 0 = 57.7%, VAS 1-3 = 19.2% and VAS ≥ 4 = 23.1% in 40-PRM group vs VAS 0 =19.2%, VAS 1-3 = 26.9% and VAS ≥ 4 = 53.9% in control group, P = 0.018), while no significant difference of PLSP between 30-PRM and control groups (P = 0.256). Other variables, such as PLSP at 24 and 48 hrs., post-operative surgical pain, nausea and vomiting, vital signs and residual gas in abdominal cavity at 24-hour were similar among three groups. Conclusions: PRM with pressure 40 cmH2 O significantly decreases PLSP at 12 hours. This procedure is feasible and safe. Using the PRM with pressure 40 cmH2 O may be applied at the end of laparoscopic procedure

An open comparative randomized prospective study: Direct trocar insertion vs Veress needle technique in laparoscopic surgeries.

Laparoscopy is a minimally invasive technique utilized for both diagnostic and surgical approaches. Minimally invasive procedures compared to laparotomy offer the advantages of reduced hospital stay, lower morbidity, decreased pain, and faster recovery. Common methods for laparoscopic entry include Veress needle insertion (VNI), direct optical trocar entry, direct trocar insertion (DTI), and the Hasson technique. This study aims to compare the efficacy and safety of VNI and DTI in laparoscopic gynecological surgeries. An open comparative randomized prospective study was conducted involving 200 women aged 18 to 70 years, scheduled for laparoscopic surgery at 2 tertiary centers. Participants were randomized into 2 groups: 1 using VNI and other using DTI. The groups were homogeneous regarding age, parity, and body mass index. The mean age of the VNI group is 45.22 ± 11.65 and the DTI group is 44.89 ± 10.5 (P = .833). There were no statistical significance in terms of the presence of chronic diseases and history of previous abdominal surgery between the groups (P = .802 and P = .510, respectively). Entry time to the abdomen, the decrease in hemoglobin values, and hospitalization length were found to be statistically significant between the entry methods (P < .001, P = .002, and P < .001, respectively). Entry time, the decrease in hemoglobin value, and hospitalization length were higher in the VNI group. In conclusion, although there is no definitive consensus on the optimal laparoscopic entry technique, direct trocar entry is an effective alternative to the Veress needle insertion technique. Direct trocar entry is associated with shorter entry times, fewer perioperative complications, less reduction in hemoglobin levels, and shorter hospitalization duration compared to VNI.

Early prediction of intraoperative hypothermia in patients undergoing gynecological laparoscopic surgery: A retrospective cohort study.

Intraoperative hypothermia is one of the most common adverse events related to surgery, and clinical practice has been severely underestimated. In view of this, this study aims to build a practical intraoperative hypothermia prediction model for clinical decision-making assistance. We retrospectively collected clinical data of patients who underwent gynecological laparoscopic surgery from June 2018 to May 2023, and constructed a multimodal algorithm prediction model based on this data. For the construction of the prediction model, all data are randomly divided into a training queue (70%) and a testing queue (30%), and then 3 types of machine learning algorithms are used, namely: random forest, artificial neural network, and generalized linear regression. The effectiveness evaluation of all predictive models relies on the comprehensive evaluation of the net benefit method using the area under the receiver operating characteristic curve, calibration curve, and decision curve analysis. Finally, 1517 screened patients were filtered and 1429 participants were included for the construction of the predictive model. Among these, anesthesia time, pneumoperitoneum time, pneumoperitoneum flow rate, surgical time, intraoperative infusion, and room temperature were independent risk factors for intraoperative hypothermia and were listed as predictive variables. The random forest model algorithm combines 7 candidate variables to achieve optimal predictive performance in 2 queues, with an area under the curve of 0.893 and 0.887 and a 95% confidence interval of 0.835 to 0.951 and 0.829 to 0.945, respectively. The prediction efficiency of other prediction models is 0.783 and 0.821, with a 95% confidence interval of 0.725 to 0.841 and 0.763 to 0.879, respectively. The intraoperative hypothermia prediction model based on machine learning has satisfactory predictive performance, especially in random forests. This interpretable prediction model helps doctors evaluate the risk of intraoperative hypothermia, optimize clinical decision-making, and improve patient prognosis.

Older age is associated with postoperative nausea and vomiting in patients receiving intravenous patient-controlled analgesia containing droperidol: A retrospective observational analysis

BackgroundThis study investigated the associations of age and other factors with postoperative nausea and vomiting (PONV) in patients receiving fentanyl and droperidol intravenous patient-controlled analgesia (IVPCA) after laparoscopic gynecological surgery. A younger age is generally considered a higher risk factor for PONV. However, in our clinical experience, older age represents a higher risk factor for patients receiving IVPCA containing fentanyl and droperidol. Thus, we hypothesized that older age was a higher risk factor, and we explored factors associated with PONV in those patients. MethodsThe incidence of PONV was investigated in 5401 patients who received fentanyl–droperidol IVPCA after laparoscopic gynecological surgery under general anesthesia. Patient characteristics, operative/anesthetic factors, and intraoperative prophylactic antiemetics were investigated by multiple logistic regression analysis to determine the relationships of these factors with PONV. ResultsAmong the 5401 patients, 4929 (91.3 %) received propofol-based anesthesia, and 5187 (96.0 %) received a prophylactic antiemetic. The overall incidences of nausea, vomiting, and postoperative antiemetic use were 36.6 %, 17.6 %, and 17.7 %, respectively. Older age was associated with a significantly higher risk (adjusted odds ratio 1.18 per 10 years, 95 % confidence interval [1.11–1.25], p < 0.001) for PONV. No PONV after previous anesthesia, entry time into the operating room, and maximum duration of IVPCA were factors that influenced the risk of PONV, together with previously identified risk factors. ConclusionsOlder age was a higher risk factor for PONV in patients receiving fentanyl–droperidol IVPCA after laparoscopic gynecological surgery.

Risk analysis of postoperative nausea and vomiting in patients after gynecologic laparoscopic surgery

AimsThis study is designed to identify risk factors of postoperative nausea and vomiting (PONV) in patients after gynecologic laparoscopic surgery and establish a nomogram model.MethodsIn this retrospective and multicenter study, we collected and analyzed data from 1233 patients who underwent gynecologic laparoscopic surgery. The Lasso algorithm was used to optimize the selection of independent variables in the development group. Multivariate logistic regression analysis was used to explore the risk factors of PONV to develop the predictive nomogram model. Finally, we used an internal and external verification group and machine learning (ML) to evaluate the accuracy and clinical applicability of the model.ResultsThe dosage of sufentanil in patient-controlled intravenous analgesia (PCIA), the dosage of remifentanil, the use of neostigmine, duration of surgery and the maximum value of the PETCO2 were risk factors of PONV in patients after gynecologic laparoscopic surgery. In contrast, the dosage of propofol during the surgery and the use of steroids were protective factors. The nomogram was then established to predict the incidence of PONV in these patients based on the above eight indicators. The C-index of the development group, internal, and external verification groups are 0.802, 0.857, and 0.966, respectively.ConclusionA nomogram model was developed to predict the incidence of PONV in patients after gynecologic laparoscopic surgery. This model was found to be reliable and of high clinical value.

Ergonomic and sustainable posture for gynecological laparoscopic surgeons determined based on images analyzed using artificial intelligence.

Studies have reported the emergence of work-related musculoskeletal disorders (WMSD) due to surgery. In fact, the usfige of long-shafted instruments has been suspected to induce WMSD in laparoscopic surgery. The present study therefore investigated whether differences in the range of motion of the face and neck, and the shoulder, elbow and hand on the dominant hand side, existed when using short- and long-shafted laparoscopic coagulation shears (LCS) during a gynecological laparoscopic surgery, based on images analyzed using artificial intelligence. After identifying the corresponding body parts in the video, the range of motion was illustrated graphically for each joint coordinate, followed by statistical analysis for changes in the position of each part. The range of motion for the face and neck did not significantly differ, whereas those for the shoulder, elbow and hand became noticeably broader when using the 36-cm long-shafted LCS than when using the 20-cm short-shafted LCS. Overall, the shorter LCS promoted a narrower range of motion compared with the 36-cm LCS, suggesting its potential for reducing the physical strain placed on the surgeon's body during gynecological laparoscopic surgery.

Evaluation of the effect of fluid management on intracranial pressure in patients undergoing laparoscopic gynaecological surgery based on the ratio of the optic nerve sheath diameter to the eyeball transverse diameter as measured by ultrasound: a randomised controlled trial

BackgroundDuring gynecological laparoscopic surgery, pneumoperitoneum and the Trendelenburg position (TP) can lead to increased intracranial pressure (ICP). However, it remains unclear whether perioperative fluid therapy impacts ICP. The purpose of this research was to evaluate the impact of restrictive fluid (RF) therapy versus conventional fluid (CF) therapy on ICP in gynecological laparoscopic surgery patients by measuring the ratio of the optic nerve sheath diameter (ONSD) to the eyeball transverse diameter (ETD) using ultrasound.MethodsSixty-four patients who were scheduled for laparoscopic gynecological surgery were randomly assigned to the CF group or the RF group. The main outcomes were differences in the ONSD/ETD ratios between the groups at predetermined time points. The secondary outcomes were intraoperative circulatory parameters (including mean arterial pressure, heart rate, and urine volume changes) and postoperative recovery indicators (including extubation time, length of post-anaesthesia care unit stay, postoperative complications, and length of hospital stay).ResultsThere were no statistically significant differences in the ONSD/ETD ratio and the ONSD over time between the two groups (all p > 0.05). From T2 to T4, the ONSD/ETD ratio and the ONSD in both groups were higher than T1 (all p < 0.001). From T1 to T2, the ONSD/ETD ratio in both groups increased by 14.3%. However, the extubation time in the RF group was shorter than in the CF group [median difference (95% CI) -11(-21 to -2) min, p = 0.027]. There were no differences in the other secondary outcomes.ConclusionIn patients undergoing laparoscopic gynecological surgery, RF did not significantly lower the ONSD/ETD ratio but did shorten the tracheal extubation time, when compared to CF.Trial registrationChiCTR2300079284. Registered on December 29, 2023.

Global recommendations on adhesion prophylaxis in gynaecological laparoscopic surgery.

Adhesions are recognised as one of the most common complications of abdominal surgery; their diagnosis and prevention remains a significant unmet need in surgical therapy, affecting negatively a patient's quality of life and healthcare budgets. In addition, postoperative pelvic adhesions pose a high risk of reduced fertility in women of childbearing age. These 2023 Global Recommendations on Adhesion Prevention in Gynaecological Laparoscopic Surgery provide agreed-upon statements to guide clinical practice, with the ultimate goal of improving patient outcomes.

Comparison of three umbilical entry sites for intraperitoneal access by the direct trocar insertion technique: a randomized pilot study.

The most effective methods and entry sites for laparoscopic surgery remain a subject of ongoing investigation and discussion. The purpose of the study was to analyze and compare three umbilical entry sites for intraperitoneal access using the direct trocar insertion technique. A randomized pilot study was conducted between March 2021 and January 2023, involving women eligible for laparoscopic gynecological surgery. The women were allocated to one of three equally sized groups based on trocar entry points: subumbilical, supraumbilical, or umbilical. Success and failure rates of trocar entry, factors influencing success or failure, and early and late complications were systematically evaluated and compared across groups. A total of 243 patients, with a mean age of 32.93±8.33 years, were included in three groups of 81 each. Trocar entry success rates were 97.5%, 89.2%, and 89.5% in the supraumbilical, umbilical, and subumbilical groups, respectively (p>0.05). Failed trocar entry was significantly associated with age, gravidity, body mass index (BMI), waist circumference, hip circumference, and abdominal subcutaneous fat thickness (p<0.001). Regression analysis revealed that, in the subumbilical group, higher gravidity [odds ratios (OR): 0.390, 95% confidence interval (CI): 0.174-0.872, p=0.022) and greater abdominal subcutaneous fat thickness (OR: 0.090, 95% CI: 0.019-0.431, p=0.03) were associated with lower odds of successful trocar entry. In contrast, in the umbilical group, a higher waist circumference was associated with lower odds of successful trocar entry (OR: 0.673, 95% CI: 0.494-0.918, p=0.012). None of the covariates were significant in the supraumbilical group. The study highlighted the importance of selecting the appropriate trocar entry site in laparoscopic gynecological surgery. Surgeons should consider factors such as age, gravidity, BMI, waist circumference, hip circumference, and abdominal subcutaneous fat thickness, as these factors significantly influence the success of trocar entry.

Effectiveness of Mechanical Bowel Preparation before Robot-Assisted Laparoscopic Gynecologic Surgery: A Randomized, Single-Blind, Controlled Trial

Objective: The objective of this randomized controlled trial was to compare the effect of bowel preparation using only oral polyethylene glycol electrolyte (PEG) solution versus oral PEG solution combined with mechanical sodium phosphate (NaP) enema on the surgical field visualization in patients undergoing robot-assisted laparoscopic gynecologic procedures. Methods: Participants were randomized to either a single oral PEG solution or an oral PEG solution combined by mechanical NaP enema. The intraoperative visualization of the surgical field, the ease of manipulation of the bowels, and overall difficulty level of the surgery were evaluated by the surgeon using a self-administered questionnaire. After the surgery, the patients completed a survey assessing postoperative gastrointestinal discomfort. Results: A total of 114 women were enrolled and randomized to oral PEG solution-only group (n = 48), and oral PEG plus mechanical NaP enema group (n = 66). Forty-two women in oral PEG-only group and 59 oral PEG plus NaP enema group completed the study. There was no difference in intraoperative visualization or overall difficulty of the operation between the two groups, and bowel manipulation was easier in the oral PEG-only group. Also, there was no difference in operating time between the groups. The patients’ level of gastrointestinal discomfort after the surgery was not significantly different between the two groups. Conclusion: Routine use of mechanical NaP enema before robot-assisted laparoscopic gynecologic surgery is not recommended, because it has no additional benefit regarding intraoperative visualization or the surgical level of difficulty over oral bowel preparation methods.

Effects of opioid-sparing general anesthesia on postoperative nausea and vomiting in laparoscopic gynecological surgery.

In this study, we aimed to investigate whether opioid-sparing anesthesia (OSA) reduces postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic gynecological surgery. Adult patients undergoing elective laparoscopic gynecological surgery were randomly assigned to either the opioid-using anesthesia (OUA) or the OSA groups. In the OUA group, remifentanil was administered as an opioid during general anesthesia. In the OSA group, apart from a single dose of 5 μg/kg of alfentanil for tracheal intubation, no other opioids were used. In both groups, a multimodal intravenous non-opioid analgesic regimen was used preferentially in the post-anesthesia care unit (PACU). The primary outcome was the incidence of PONV, assessed by symptoms until the postoperative day (POD) 1. A total of 120 patients were included in this study. The incidence of nausea in the PACU was significantly lower in the OSA group compared to in the OUA group (31.7% in the OSA group vs. 51.7% in the OUA group, P = 0.026). Pain scores and the incidence of opioid analgesic administration were lower in the OSA group during PACU stay, resulting in a significantly lower number of patients requiring rescue opioid analgesics (3.3% vs. 18.3%, P = 0.008). There were no significant differences in intraoperative vital signs, hemodynamic interventions, or duration of PACU and hospital stay between the two groups. OSA significantly reduced postoperative nausea, pain scores, and the need for rescue analgesics in the PACU without increasing hemodynamic instability in patients undergoing laparoscopic gynecological surgery.

Addition of nitrous oxide and oxygen to carbon dioxide pneumoperitoneum during laparoscopic surgery for pain reduction: A double-blinded randomized controlled trial.

To examine if peritoneal conditioning with an altered insufflation gas mixture is associated with reduced postoperative pain intensity compared to the standard insufflation gas (i.e., 100% CO2). A prospective, single-centre, randomized, double-blind, superiority trial was performed. This study was conducted between 4 April 2019 and 10 February 2022 at the Jessa Hospital, Hasselt, Belgium. Patients scheduled for elective gynaecologic laparoscopic surgery. Seventy-four patients scheduled for elective gynaecologic laparoscopic surgery were randomised to receive either the standard insufflation gas with 100 CO2 (n = 37; control group) or the altered gas mixture of 86% CO2, 10% N2O and 4% O2 (n = 37; experimental group). Postoperative pain was assessed at 4, 8 and 24 hours after surgery and on postoperative day (POD) 7 by an 11-point Numeric Rating Scale, with 0 indicating no pain and 10 indicating worst imaginable pain. No significant differences were found between the control and experimental groups regarding postoperative pain at 4, 8 and 24 h after surgery, as well as on POD7. In addition, the median (25% and 75%) total amount of IV piritramide consumption during the first 24 h after surgery was not significantly different between groups (control group: 18.0 [10.0, 27.0] mg vs. experimental group: 17.0 [10.0, 34.0] mg, p = 0.62). The alternative insufflation gas mixture comprising 86% CO2, 10% N2O and 4% O2 used for the pneumoperitoneum during gynaecologic laparoscopic surgery does not appear to reduce postoperative pain compared to the standard insufflation gas of 100% CO2.

Effect of A118G (rs1799971) single-nucleotide polymorphism of the μ-opioid receptor OPRM1 gene on intraoperative remifentanil requirements in Japanese women undergoing laparoscopic gynecological surgery.

Abundant data are available on the effect of the A118G (rs1799971) single-nucleotide polymorphism (SNP) of the μ-opioid receptor OPRM1 gene on morphine and fentanyl requirements for pain control. However, data on the effect of this SNP on intraoperative remifentanil requirements remain limited. We investigated the effect of this SNP on intraoperative remifentanil requirements. We investigated 333 Japanese women, aged 21-69 years, who underwent laparoscopic gynecological surgery for benign gynecological disease under total intravenous anesthesia at Juntendo University Hospital. Average infusion rates of propofol and remifentanil during anesthesia and the average bispectral index (BIS) during surgery were recorded. Associations among genotypes of the A118G and phenotypes were examined with the Mann-Whitney U test. The average propofol infusion rate was not different between patients with different genotypes. The average remifentanil infusion rate was significantly higher in patients with the AG or GG genotype than the AA genotype (p = 0.028). The average intraoperative BIS was significantly higher in patients with the GG genotype than the AA or AG genotype (p = 0.039). The G allele of the A118G SNP was associated with higher intraoperative remifentanil requirements and higher intraoperative BIS values but was not associated with propofol requirements. Given that remifentanil and propofol act synergistically on the BIS, these results suggest that the G allele of the A118G SNP is associated with lower effects of remifentanil in achieving adequate intraoperative analgesia and in potentiating the sedative effect of propofol on the BIS.

Predictive value of preoperative ultrasonographic measurement of gastric morphology for the occurrence of postoperative nausea and vomiting among patients undergoing gynecological laparoscopic surgery.

Pre-operative prediction of postoperative nausea and vomiting (PONV) is primarily based on the patient's medical history. The predictive value of gastric morphological parameters observed on ultrasonography has not been comprehensively assessed. A prospective observational study was conducted to evaluate the pre-operative ultrasonographic measurement of gastric morphology for predicting PONV. The gastric antrum of the participants was assessed using ultrasound before anesthesia, and the occurrence of PONV in the first 6 hours and during the 6-24 hours after surgery was reported. The main indicators included the thickness of the muscularis propria (TMP) and the cross-sectional area of the inner side of the muscularis propria (CSA-ISMP). These were recorded and analyzed. Logistic regression analysis was applied to identify factors for PONV. A total of 72 patients scheduled for elective gynecological laparoscopic surgery were investigated in the study. The pre-operative CSA-ISMP of patients with PONV in the first 6 hours was significantly greater than that of those without PONV (2.765 ± 0.865 cm² vs 2.349 ± 0.881 cm², P=0.0308), with an area under the curve of 0.648 (95% CI, 0.518 to 0.778, P=0.031). Conversely, the pre-operative TMP of patients with PONV during the 6-24 hours was significantly smaller than that of those without PONV (1.530 ± 0.473mm vs 2.038 ± 0.707mm, P=0.0021), with an area under the curve of 0.722 (95% CI, 0.602 to 0.842, P=0.003). Logistic regression analysis confirmed that CSA-ISMP was an independent risk factor for PONV in the first 6 hours (OR=2.986, P=0.038), and TMP was an independent protective factor for PONV during the 6-24 hours after surgery (OR=0.115, P=0.006). Patients with a larger pre-operative CSA-ISMP or a thinner TMP are prone to develop PONV in the first 6 hours or during the 6-24 hours after surgery, respectively. http://www.chictr.org.cn (ChiCTR2100055068).

Preoperative Anxiolysis and Treatment Expectation (PATE Trial): open-label placebo treatment to reduce preoperative anxiety in female patients undergoing gynecological laparoscopic surgery - study protocol for a bicentric, prospective, randomized-controlled trial.

One of the most common concerns of patients undergoing surgery is preoperative anxiety, with a prevalence of up to 48%. The effects of preoperative anxiety continue beyond the preoperative period and are associated with more severe postoperative pain and poorer treatment outcomes. Treatment options for preoperative anxiety are often limited as sedatives cause side effects and their efficacy remains controversial. Placebo research has shown that optimization of positive treatment expectations, as can be achieved through placebo administration and education, has clinically relevant effects on preoperative anxiety, pain and treatment outcomes. As the administration of masked placebos raises ethical questions, clinical studies have increasingly focused on the use of open, non-deceptive placebo administration (open-label placebo, OLP). The use of OLPs to reduce preoperative anxiety and modify clinically relevant postoperative outcomes has not yet been investigated. This bicentric, prospective, randomized-controlled clinical trial (PATE Trial; German Registry for Clinical Studies DRKS00033221), an associated project of the Collaborative Research Center (CRC) 289 "Treatment Expectation", aims to alleviate preoperative anxiety by optimizing positive treatment expectations facilitated by OLP. Furthermore, this study examines a potential enhancement of these effects through aspects of observational learning, operationalized by a positive expectation-enhancing video. In addition, patient's perspective on the self-efficacy and appropriateness of OLPs prior to surgery will be assessed. To achieve these objectives, female patients will be randomized into three groups before undergoing gynecological laparoscopic surgery. One group receives the OLP with a positive rationale conveyed by a study physician. A second group receives the same intervention, OLP administration and rationale provided by a physician, and additionally watches a video on OLP presenting a satisfied patient. A third group receives standard treatment as usual (TAU). Outcome measures will be effects on preoperative anxiety and postoperative experience, particularly visceral and somatic postoperative pain. As the non-deceptive administration of placebos; when indicated; may yield positive outcomes without side effects, and as current treatment of preoperative anxiety is limited, evidence from clinical placebo research has the potential to improve outcomes and patient experience in the surgical setting.

An Inceptive Period of Gynecological Laparoscopic Surgery in Nepal Police Hospital – A Retrospective Cross-sectional Study

Introduction: Laparoscopy in gynecology has evolved historically from limited procedures like diagnostic laparoscopy and tubal ligations and now has developed to a multitude of advance gynecologic surgeries. The aim of this study was to review the early experience of gynecological laparoscopic surgery in Nepal police hospital. Methods: This is a retrospective study done in Nepal Police Hospital from April 14, 2018 to April 13, 2023. Data were obtained from the hospital records. All the laparoscopic Gynecological surgeries performed during this period were analyzed in terms of age group, entry technique, indication and type of surgical procedure, conversion to laparotomy and complications. Results: A total of 243 Gynecological laparoscopic surgeries were performed during the study period. The most common age group was between 26 to 30 years (24.69 %) and 31 to 35 years (17.69 %). The most common indication for laparoscopic surgery was adnexal cyst (36.21 %) and fibroid uterus (19.99 %). The most common surgery performed was cystectomy or Salpingo-oopherectomy for adnexal cyst (36.21 %) and Total Laparoscopic Hysterectomy (25.92 %). Conversion to laparotomy was 2.46 %. The incidence of major complication was 6.17 %. Conclusion: The increasing preference of laparoscopic surgery over the period of time in our institution indicates the improvement in surgical skills, satisfactory results and improved awareness of laparoscopic procedures among the patients.