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

Study objective: 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.

Design: Prospective cohort of women taking part in a POP surgical registry.

Setting: Tertiary academic hospital in Calgary, Canada.

Patients: 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.

Interventions: 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.

Measurements and main results: Postoperative opioid use 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%) used a 10-12 mm LAP, and 42 cases (45.7%) used an 8 mm LAP. Mean morphine 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 results remained statistically significant after adjustment for age, body mass index, race and ethnicity, length of procedure, and concomitant procedures performed.

Conclusion: 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.