A comparison of postoperative pain after transumbilical single-port access and conventional three-port total laparoscopic hysterectomy: a randomized controlled trial.
BACKGROUND
The objective of this study was to compare postoperative pain between single-port access total laparoscopic hysterectomy (SPA-TLH) using a transumbilical single-port system and conventional multi (three)-port access total laparoscopic hysterectomy (MPA-TLH).


METHODS
A randomized controlled trial was conducted on 60 women who underwent SPA-TLH and MPA-TLH for benign gynecologic diseases between March 2014 and January 2015. Patients were randomly assigned to undergo SPA-TLH (n = 30) or MPA-TLH (n = 30). The variables measured included surgical outcomes and postoperative pain at 30 min and 1, 12, 24, and 48 h after surgery, assessed by the visual analog scale, bolus requirement of intravenous patient-controlled analgesia, and additional analgesic use.


RESULTS
The two study groups did not differ in terms of patient demographics or surgical outcomes except for operative time. The SPA-TLH group had a longer operative time (p < 0.0001) compared with the MPA-TLH groups. There were no differences in pain scores between the two groups. The SPA-TLH group had significantly more intravenous analgesia requests during the 12-24 h after surgery (2.17 ± 3.05 vs. 0.79 ± 1.99; p = 0.047), more 24-48 h postoperative analgesics (0.21 ± 0.41 vs. 0.03 ± 0.19; p = 0.045), and more total additional analgesics (0.97 ± 0.94 vs. 0.45 ± 0.87; p = 0.034).


CONCLUSIONS
SPA-TLH was feasible compared with MPA-TLH but the SPA-TLH group had a longer operative time. Although there is no difference in pain based on the visual analog scale pain score, the SPA-TLH group required more analgesia to give the same postoperative pain control.
Department of Anesthesiology and Pain Medicine, Catholic University of Korea, Seoul, Korea.
Ji-Hyun
http://orcid.org/0000-0002-8600-9107
JH
Chung
Department of General Surgery, Catholic University of Korea, Seoul, Korea.
Jong Min
http://orcid.org/0000-0001-5260-3821
JM
Baek
Department of Anesthesiology and Pain Medicine, Catholic University of Korea, Seoul, Korea.
Kyudon
http://orcid.org/0000-0001-5374-9689
K
Chung
Department of Obstetrics and Gynecology, Catholic University of Korea, Seoul, Korea.
Eun Kyung
http://orcid.org/0000-0002-0203-6731
EK
Park
Department of Obstetrics and Gynecology, Catholic University of Korea, Seoul, Korea.
In Cheul
http://orcid.org/0000-0002-5567-3195
IC
Jeung
Department of Anesthesiology and Pain Medicine, Catholic University of Korea, Seoul, Korea.
Hyun Tae
HT
Chang
Department of Obstetrics and Gynecology, Seoul Medical Center, Seoul, Korea.
Ji Hyang
http://orcid.org/0000-0001-8917-6747
JH
Choi
Department of Obstetrics and Gynecology, Catholic University of Korea, Seoul, Korea.
Chan Joo
http://orcid.org/0000-0001-8857-3134
CJ
Kim
Department of Obstetrics and Gynecology, Catholic University of Korea, Seoul, Korea.
Yong Seok
http://orcid.org/0000-0001-5637-3429
YS
Lee
D016058:Analgesia, Patient-Controlled; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology* / Q000517:prevention & control*; D011446:Prospective Studies; D056910:Republic of Korea / Q000453:epidemiology; D016896:Treatment Outcome; D014472:Umbilicus
Postoperative pain; hysterectomy; multi-port; single-port; total laparoscopic hysterectomy; visual analogue scale