How Low Can You Go: a Randomized Controlled Trial of Normal Versus Low Intraabdominal Pressure During Laparoscopic Uterosacral Suspension Surgery

The primary objective of this research proposal is to answer the question: in patients scheduled to undergo laparoscopic uterosacral suspension surgery of the uterus or vaginal vault, does lower intraabdominal operating pressure reduce post-operative pain, measured using a standardized visual analogue scale?

Secondary outcomes include frequency of opioid and non-opioid analgesic prescriptions at time of discharge, rescue opioid analgesics in the day-surgery recovery unit, rate of unanticipated admission to hospital. Surgical safety outcomes will also be assessed including surgeon perception of operative field visibility, rate of surgeon requests to increase intraabdominal pressure, rate of conversion to open surgery, incidence of surgical complications (up to 30d post-operatively).

3.0 METHODS & STATISTICAL ANALYSIS This study will be a double-blinded randomized controlled trial patients ≥18 years of age scheduled for laparoscopic uterosacral suspension surgery of either the uterus or vaginal vault at the Foothills Medical Centre, an academic tertiary hospital. Patients scheduled to receive concomitant prolapse, hysterectomy, or anti-incontinence surgeries will be included. Patients scheduled to receive concomitant non-urogynecologic surgery or those converted to an open, abdominal surgical approach will be excluded. For participants randomized to the lower IAP group, after entry into the abdominal-pelvic cavity, pneumoperitoneum pressure will be set and maintained at 10mmHg throughout the surgery. For those randomized to the normal IAP group, after entry into the abdominal-pelvic cavity, pneumoperitoneum pressure will be set and maintained at 15mmHg.

Data collected - including but not limited to:

1. Preoperative data: