Logo image
Back
Umbilical Morcellation and Postoperative Pain in Patients Undergoing Benign Hysterectomy
Journal article   Open access   Peer reviewed

Umbilical Morcellation and Postoperative Pain in Patients Undergoing Benign Hysterectomy

Colette Gnade and Kelly Kasper
Journal of the Society of Laparoendoscopic Surgeons, Vol.29(1), e2024.00052
01/2025
DOI: 10.4293/JSLS.2024.00052
PMCID: PMC11967719
PMID: 40182836
url
https://doi.org/10.4293/JSLS.2024.00052View
Published (Version of record) Open Access

Abstract

Morcellation has allowed patients with enlarged uteri to obtain a minimally invasive hysterectomy with improved outcomes; however, there is little information regarding postoperative pain. Our study aims to compare pain scores and opioid requirements in patients undergoing umbilical morcellation during benign minimally invasive hysterectomy versus those who do not require morcellation. A retrospective cohort study was performed at a tertiary care center including patients who underwent total laparoscopic or supracervical hysterectomy by one high volume surgeon from 2019 to 2022. Baseline characteristics, postoperative pain scores, and morphine milligram equivalents in the acute and late setting were recorded. Two-sample test for continuous variables and χ or Fisher's exact test for categorical variables were used to compare differences. A multiple regression model evaluated the effect of groups with the adjustment of confounders. A total of 232 patients underwent hysterectomy in which 57 underwent umbilical manual morcellation and 175 did not. There was no difference in postoperative complications, readmissions, or blood products required (  > 0.05). Individuals that underwent umbilical morcellation had longer operative times (226.6 vs 120.1 minutes,  < 0.01), more blood loss (311.1 vs 82.0 mL,  < 0.01), longer length of stay (0.60 vs 0.44 days,  < 0.01), increased uterine weight (1,293.2 vs 151.6 g,  < 0.01), and fibroid pathology (93.0% vs 46.3%,  < 0.01). There were no differences in postoperative pain scores, immediate and later opioid use between groups on multivariate analysis. Patients who undergo umbilical morcellation, typically for large fibroid uteri, have similar postoperative pain scores, opioid use, and postoperative complications to those who undergo hysterectomy for other indications.
 Adult Analgesics, Opioid - therapeutic use Female Humans Hysterectomy - adverse effects Hysterectomy - methods Laparoscopy - methods Middle Aged Morcellation - adverse effects Morcellation - methods Operative Time Pain Measurement Pain, Postoperative - drug therapy Pain, Postoperative - epidemiology Pain, Postoperative - etiology Retrospective Studies Umbilicus - surgery

Details

Metrics

4 Record Views
Logo image