Evaluating the Effect of Saline Washout on Pain After Low-Pressure vNOTES Hysterectomy

What this Trial Is About

Researchers are investigating postoperative pain management in women undergoing vNOTES Vaginal Natural Orifice Transluminal Endoscopic Surgery hysterectomy, a minimally invasive gynecologic surgery that combines endoscopic visualization with a scarless vaginal approach. Although vNOTES uses lower pressure pneumoperitoneum than traditional laparoscopy and offers benefits like less pain and faster recovery, post-laparoscopic pain syndrome PLPS remains a challenge. This trial aims to assess whether adding an intraperitoneal saline washout to low-pressure vNOTES further reduces pain and analgesic use after surgery. The study compares two groups of women scheduled for elective total hysterectomy using low-pressure vNOTES at 8 mmHg pneumoperitoneum. One group receives only the low-pressure vNOTES procedure, while the other group also receives a warm saline washout 25 mLkg at 370C at the end of surgery to wash out residual carbon dioxide and acidic metabolites. Additional surgeries like salpingectomy or oophorectomy may be performed as needed during the procedure. Participants will be followed to measure pain levels using the Visual Analogue Scale VAS 24 hours after surgery as the primary outcome. Researchers will monitor analgesic consumption and recovery progress, with all participants providing informed consent and able to complete pain and recovery questionnaires. The study uses a randomized, triple-masked design to compare outcomes and is sponsored by Erzincan Military Hospital.

Does Intraperitoneal Washout Further Reduce Pain After Low-Pressure vNOTES Hysterectomy?