Insufflation Pressure and Pain After Single-Port Robotic Sacrocolpopexy

Importance Pneumoperitoneum can result in peritoneal irritation and referred postoperative pain. Objective The objective of this study was to assess if decreasing insufflation pressure during single-port (SP) robotic sacrocolpopexy decreased postoperative pain Study Design We performed a double-blinded randomized trial of women undergoing SP robotic sacrocolpopexy at 15 mm Hg (standard) or 12 mm Hg (experimental) insufflation pressure. The primary objective was to assess the effect of insufflation pressure on postoperative day (POD)1 pain. The effect on surgeon visualization was included as a secondary objective. Pain was assessed using a 100-point Numeric Rating Scale (NRS). Surgeons were asked to rate the intraoperative visibility as “improved,” “unchanged,” or “worse” after surgery completion. A sample size of 64 participants was needed to have 80% power to detect a clinically significant difference of 15 on POD1 pain NRS between groups. Standard group comparisons were utilized for categorical and continuous variables. Results Seventy-one participants were randomized to experimental or standard insufflation pressure. The median (range) baseline preoperative pain score was 0 (0–0). In 69 cases (97.2%), the surgeon reported “unchanged” visualization. When comparing postoperative pain, lower pressure (experimental group) was associated with a lower POD1 pain score (26 vs 50, P < 0.001). Conclusion Decreasing insufflation pressure by 3 mm Hg resulted in decreased postoperative pain without compromising surgeon visibility.