{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T08:50:15Z","timestamp":1768726215976,"version":"3.49.0"},"reference-count":36,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,4,13]],"date-time":"2022-04-13T00:00:00Z","timestamp":1649808000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Our objective was to evaluate postoperative pain and opioid consumption in patients undergoing hysterectomy by low-impact laparoscopy and compare these parameters with conventional laparoscopy. We conducted a prospective study in two French gynecological surgery departments from May 2017 to January 2018. The primary endpoint was the intensity of postoperative pain evaluated by a validated numeric rating scale (NRS) and opioid consumption in the postoperative recovery unit on Day 0 and Day 1. Thirty-two patients underwent low-impact laparoscopy and 77 had conventional laparoscopy. Most of the patients (90.6%) who underwent low-impact laparoscopy were managed as outpatients. There was a significantly higher consumption of strong opioids in the conventional compared to the low-impact group on both Day 0 and Day 1: 26.0% and 36.4% vs. 3.1% and 12.5%, respectively (p = 0.02 and p &lt; 0.01). Over two-thirds of the patients in the low-impact group did not require opioids postoperatively. Two factors were predictive of lower postoperative opioid consumption: low-impact laparoscopy (OR 1.38, 95%CI 1.13\u20131.69, p = 0.002) and a mean intraoperative peritoneum below 10 mmHg (OR 1.25, 95%CI 1.03\u20131.51). Total hysterectomy by low-impact laparoscopy is feasible in an outpatient setting and is associated with a marked decrease in opioid consumption compared to conventional laparoscopy.<\/jats:p>","DOI":"10.3390\/jcm11082165","type":"journal-article","created":{"date-parts":[[2022,4,13]],"date-time":"2022-04-13T21:33:42Z","timestamp":1649885622000},"page":"2165","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Total Hysterectomy by Low-Impact Laparoscopy to Decrease Opioids Consumption: A Prospective Cohort Study"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9353-6036","authenticated-orcid":false,"given":"Yohann","family":"Dabi","sequence":"first","affiliation":[{"name":"Sorbonne University, 75006 Paris, France"},{"name":"Obstetrics and Gynecology Department, Tenon Hospital, Assistance Publique des H\u00f4pitaux de Paris (AP-HP), 75020 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samia","family":"Ouasti","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Department, Tenon Hospital, Assistance Publique des H\u00f4pitaux de Paris (AP-HP), 75020 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H\u00e9l\u00e8ne","family":"Didelot","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Department, Intercommunal Hospital of Creteil, 94000 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henri","family":"Wohrer","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Department, Intercommunal Hospital of Creteil, 94000 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dounia","family":"Skalli","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Department, Intercommunal Hospital of Creteil, 94000 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregoire","family":"Miailhe","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Department, Intercommunal Hospital of Creteil, 94000 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Uzan","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Department, Intercommunal Hospital of Creteil, 94000 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cl\u00e9ment","family":"Ferrier","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Department, Tenon Hospital, Assistance Publique des H\u00f4pitaux de Paris (AP-HP), 75020 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sofiane","family":"Bendifallah","sequence":"additional","affiliation":[{"name":"Sorbonne University, 75006 Paris, France"},{"name":"Obstetrics and Gynecology Department, Tenon Hospital, Assistance Publique des H\u00f4pitaux de Paris (AP-HP), 75020 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bassam","family":"Haddad","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Department, Intercommunal Hospital of Creteil, 94000 Paris, France"},{"name":"University of Medicine Paris Est Cr\u00e9teil, 94000 Cr\u00e9teil, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emile","family":"Dara\u00ef","sequence":"additional","affiliation":[{"name":"Sorbonne University, 75006 Paris, France"},{"name":"Obstetrics and Gynecology Department, Tenon Hospital, Assistance Publique des H\u00f4pitaux de Paris (AP-HP), 75020 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cyril","family":"Touboul","sequence":"additional","affiliation":[{"name":"Sorbonne University, 75006 Paris, France"},{"name":"Obstetrics and Gynecology Department, Tenon Hospital, Assistance Publique des H\u00f4pitaux de Paris (AP-HP), 75020 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1111\/1471-0528.15539","article-title":"Route of hysterectomy: A retrospective, cohort study in English NHS hospitals from 2011 to 2017","volume":"126","author":"Madhvani","year":"2019","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Moawad, G., Liu, E., Song, C., and Fu, A.Z. (2017). Movement to outpatient hysterectomy for benign indications in the United States, 2008\u20132014. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0188812"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"202.e1","DOI":"10.1016\/j.ajog.2020.08.014","article-title":"Trends in operative time and outcomes in minimally invasive hysterectomy from 2008 to 2018","volume":"224","author":"Luchristt","year":"2021","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1928","DOI":"10.1007\/s00464-008-9867-2","article-title":"A meta-analysis of ambulatory versus inpatient laparoscopic cholecystectomy","volume":"22","author":"Ahmad","year":"2008","journal-title":"Surg. Endosc."},{"key":"ref_5","first-page":"6177","article-title":"Clinical and cost implications of inpatient versus outpatient orthopedic surgeries: A systematic review of the published literature","volume":"7","author":"Crawford","year":"2015","journal-title":"Orthop. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s40463-020-00484-9","article-title":"Outpatient versus inpatient superficial parotidectomy: Clinical and pathological characteristics","volume":"50","author":"Lee","year":"2021","journal-title":"J. Otolaryngol.-Head Neck Surg. J. Oto-Rhino-Laryngol. Chir. Cervico-Faciale"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"g1251","DOI":"10.1136\/bmj.g1251","article-title":"Rates and risk factors for prolonged opioid use after major surgery: Population based cohort study","volume":"348","author":"Clarke","year":"2014","journal-title":"BMJ"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e170504","DOI":"10.1001\/jamasurg.2017.0504","article-title":"New persistent opioid use after minor and major surgical procedures in US adults","volume":"152","author":"Brummett","year":"2017","journal-title":"JAMA Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1089\/gyn.1989.5.213","article-title":"Laparoscopic hysterectomy","volume":"5","author":"Reich","year":"1989","journal-title":"J. Gynecol. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1007\/s13304-018-0591-8","article-title":"The protocol of low-impact laparoscopic cholecystectomy: The combination of mini-laparoscopy and low-pressure pneumoperitoneum","volume":"70","author":"Petrucciani","year":"2018","journal-title":"Updat. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.amjsurg.2013.09.027","article-title":"Low-pressure versus standard-pressure pneumoperitoneum for laparoscopic cholecystectomy: A systematic review and meta-analysis","volume":"208","author":"Hua","year":"2014","journal-title":"Am. J. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jogoh.2016.09.003","article-title":"Low pressure gynecological laparoscopy (7mmHg) with AirSeal\u00ae System versus a standard insufflation (15mmHg): A pilot study in 60 patients","volume":"46","author":"Sroussi","year":"2017","journal-title":"J. Gynecol. Obstet. Hum. Reprod."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1186\/1745-6215-15-239","article-title":"Comparison of a standard CO\u2082 pressure pneumoperitoneum insufflator versus AirSeal: Study protocol of a randomized controlled trial","volume":"15","author":"Luketina","year":"2014","journal-title":"Trials"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1089\/end.2012.0632","article-title":"Prospective comparison between the AirSeal\u00ae System valve-less Trocar and a standard VersaportTM Plus V2 Trocar in robotic-assisted radical prostatectomy","volume":"27","author":"Horstmann","year":"2013","journal-title":"J. Endourol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1016\/j.jpainsymman.2010.08.016","article-title":"Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: A systematic literature review","volume":"41","author":"Hjermstad","year":"2011","journal-title":"J. Pain Symptom Manage."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2399","DOI":"10.1016\/j.pain.2011.07.005","article-title":"Validity of four pain intensity rating scales","volume":"152","author":"Jensen","year":"2011","journal-title":"Pain"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1097\/00002508-200003000-00005","article-title":"A Comparison of pain rating scales by sampling from clinical trial data","volume":"16","author":"Breivik","year":"2000","journal-title":"Clin. J. Pain"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1515\/sjpain-2018-0012","article-title":"The validity of pain intensity measures: What do the NRS, VAS, VRS, and FPS-R measure?","volume":"18","author":"Thong","year":"2018","journal-title":"Scand. J. Pain"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Bijen, C.B.M., Vermeulen, K.M., Mourits, M.J.E., and de Bock, G.H. (2009). Costs and effects of abdominal versus laparoscopic hysterectomy: Systematic review of controlled trials. PLoS ONE, 4.","DOI":"10.1371\/journal.pone.0007340"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"5331","DOI":"10.1200\/JCO.2009.22.3248","article-title":"Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic oncology group study LAP2","volume":"27","author":"Walker","year":"2009","journal-title":"J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1016\/j.ajog.2015.07.038","article-title":"An update on inpatient hysterectomy routes in the United States","volume":"213","author":"Desai","year":"2015","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1007\/s11701-020-01101-7","article-title":"Safety and feasibility of the three-port robot-assisted hysterectomy across uterine weights","volume":"15","author":"Tyan","year":"2021","journal-title":"J. Robot. Surg."},{"key":"ref_23","first-page":"179","article-title":"Minilaparoscopy in gynecology: Applications, benefits and limitations","volume":"73","author":"Casarin","year":"2021","journal-title":"Minerva Ginecol."},{"key":"ref_24","unstructured":"(2022, March 01). West-Sussex-Drug-Related-Deaths-Audit-2019.Pdf, Available online: https:\/\/jsna.westsussex.gov.uk\/updates\/drug-related-deaths-audit-2019\/."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2164","DOI":"10.1007\/s00268-019-05016-9","article-title":"Chronic postoperative opioid use: A systematic review","volume":"43","author":"Hinther","year":"2019","journal-title":"World J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1016\/S0140-6736(19)30428-3","article-title":"Inappropriate opioid prescription after surgery","volume":"393","author":"Neuman","year":"2019","journal-title":"Lancet Lond. Engl."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1097\/SLA.0000000000002591","article-title":"Opioid use after discharge in postoperative patients: A systematic review","volume":"267","author":"Feinberg","year":"2018","journal-title":"Ann. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1016\/j.ajog.2016.12.175","article-title":"Non-opioid pain management in benign minimally invasive hysterectomy: A systematic review","volume":"216","author":"Blanton","year":"2017","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1111\/jog.12354","article-title":"Minilaparoscopic hysterectomy made easy: First report on alternative instrumentation and new integrated energy platform","volume":"40","author":"Ng","year":"2014","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1089\/lap.2014.0478","article-title":"Minilaparoscopic versus standard laparoscopic hysterectomy for uteri \u226516 weeks of gestation: Surgical outcomes, postoperative quality of life, and cosmesis","volume":"25","author":"Uccella","year":"2015","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1007\/s00464-009-0827-2","article-title":"Creation of pneumoperitoneum: Noninvasive monitoring of clinical effects of elevated intraperitoneal pressure for the insertion of the first trocar","volume":"24","author":"Azevedo","year":"2010","journal-title":"Surg. Endosc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1007\/s00464-001-9166-7","article-title":"The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery","volume":"16","author":"Neudecker","year":"2002","journal-title":"Surg. Endosc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1969","DOI":"10.1007\/s00268-005-0752-z","article-title":"Combined low pressure pneumoperitoneum and intraperitoneal infusion of normal saline for reducing shoulder tip pain following laparoscopic cholecystectomy","volume":"30","author":"Esmat","year":"2006","journal-title":"World J. Surg."},{"key":"ref_34","first-page":"757","article-title":"Lactate and acid base changes during laparoscopic cholecystectomy","volume":"18","author":"Ibraheim","year":"2006","journal-title":"Middle East J. Anaesthesiol."},{"key":"ref_35","first-page":"172575","article-title":"The effects of different insufflation pressures on liver functions assessed with LiMON on patients undergoing laparoscopic cholecystectomy","volume":"2012","author":"Sezer","year":"2012","journal-title":"Sci. World J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1007\/s00464-003-8819-0","article-title":"Changes in the blood coagulation, fibrinolysis, and cytokine profile during laparoscopic and open cholecystectomy","volume":"18","author":"Schietroma","year":"2004","journal-title":"Surg. Endosc."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/8\/2165\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:52:57Z","timestamp":1760136777000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/8\/2165"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,13]]},"references-count":36,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["jcm11082165"],"URL":"https:\/\/doi.org\/10.3390\/jcm11082165","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,13]]}}}