Jennifer Klauschie

Use of Anti-Skid Material and Patient-Positioning To Prevent Patient Shifting during Robotic-Assisted Gynecologic Procedures

STUDY OBJECTIVE To estimate patient shifting with the current practice of use of an antiskid material and patient positioning during robotic procedures in gynecology. DESIGN Pilot observational study (Canadian Task Force classification). SETTING Tertiary referral center. PATIENTS Twenty-two women undergoing robotic-assisted gynecologic procedures. INTERVENTION Antiskid material (egg-crate pink foam) was placed beneath patients and patient positioning was used during robotic-assisted procedures. MEASUREMENTS AND MAIN RESULTS Patient position was marked before and after surgery. Measurements of shift distance before and after surgery were determined for each patient. Median (range) shift distance was 1.3 (0-7.5) cm. There was no significant association between shift in position and either body mass index or duration of the Trendelenburg position. No shoulder neuropathic injuries were observed during the study. CONCLUSION Minimal patient shifting is observed with the use of an antiskid material and patient positioning described, without the use of shoulder braces and straps.

Surgical treatment of vaginal vault prolapse: a historic summary and review of outcomes.

Objectives This study aimed to review the history of surgical treatment of vaginal vault prolapse, its current treatments, and its outcomes. Methods A PubMed search was conducted using the following terms: vaginal vault prolapse, apical prolapse, surgical treatments, culdoplasty, uterosacral ligament fixation, and sacral colpopexy. Results Vaginal vault prolapse is a common condition with many surgical treatment options. Surgical principles and treatment of this condition dates back to the 19th century. Native tissue repairs such as McCall culdoplasty, uterosacral ligament fixation, and sacrospinous fixation have high overall success rates with restoring apical anatomy. Sacral colpopexy also has excellent success rates when mesh is needed to augment repairs. Conclusions There are many options for the treatment of vaginal vault prolapse. Modifications have been made to the original procedures; however, the basic principles are still applicable and include attaching the vaginal apex to level 1 support.

The effect of rectal distension on bladder function in patients with overactive bladder.

To investigate the effect of rectal distension on bladder sensation volumes and the number of detrusor contractions in patients with overactive bladder (OAB) symptoms.

Robotic presacral neurectomy - technique and results

The feasibility, safety and outcomes of robotic presacral neurectomy were evaluated.

Randomized controlled trial of postoperative belladonna and opium rectal suppositories in vaginal surgery

BACKGROUND: After vaginal surgery, oral and parenteral narcotics are used commonly for pain relief, and their use may exacerbate the incidence of sedation, nausea, and vomiting, which ultimately delays convalescence. Previous studies have demonstrated that rectal analgesia after surgery results in lower pain scores and less intravenous morphine consumption. Belladonna and opium rectal suppositories may be used to relieve pain and minimize side effects; however, their efficacy has not been confirmed. OBJECTIVE: We aimed to evaluate the use of belladonna and opium suppositories for pain reduction in vaginal surgery. MATERIALS AND METHODS: A prospective, randomized, double‐blind, placebo‐controlled trial that used belladonna and opium suppositories after inpatient or outpatient vaginal surgery was conducted. Vaginal surgery was defined as (1) vaginal hysterectomy with uterosacral ligament suspension or (2) posthysterectomy prolapse repair that included uterosacral ligament suspension and/or colporrhaphy. Belladonna and opium 16A (16.2/60 mg) or placebo suppositories were administered rectally immediately after surgery and every 8 hours for a total of 3 doses. Patient‐reported pain data were collected with the use of a visual analog scale (at 2, 4, 12, and 20 hours postoperatively. Opiate use was measured and converted into parenteral morphine equivalents. The primary outcome was pain, and secondary outcomes included pain medication, antiemetic medication, and a quality of recovery questionnaire. Adverse effects were surveyed at 24 hours and 7 days. Concomitant procedures for urinary incontinence or pelvic organ prolapse did not preclude enrollment. RESULTS: Ninety women were randomly assigned consecutively at a single institution under the care of a fellowship‐trained surgeon group. Demographics did not differ among the groups with mean age of 55 years, procedure time of 97 minutes, and prolapse at 51%. Postoperative pain scores were equivalent among both groups at each time interval. The belladonna and opium group used a mean of 57 mg morphine compared with 66 mg for placebo (P=.43) in 24 hours. Patient satisfaction with recovery was similar (P=.59). Antiemetic and ketorolac use were comparable among groups. Subgroup analyses of patients with prolapse and patients <50 years old did not reveal differences in pain scores. The use of belladonna and opium suppositories was uncomplicated, and adverse effects, which included constipation and urinary retention, were similar among groups. CONCLUSION: Belladonna and opium suppositories are safe for use after vaginal surgery. Belladonna and opium suppositories did not reveal lower pain or substantially lower narcotic use. Further investigation may be warranted to identify a population that may benefit optimally from belladonna and opium use.

7: Randomized clinical trial of postoperative belladonna and opium (B&O) suppositories in vaginal surgery

7 Randomized clinical trial of postoperative belladonna and opium (B&O) suppositories in vaginal surgery K. A. Butler, J. Yi, J. Klauschie, D. L. Ryan, J. G. Hentz, J. L. Cornella, P. Magtibay, R. Kho Gynecology, Mayo Clinic Arizona, Phoenix, AZ, Clinical Studies, Mayo Clinic Arizona, Phoenix, AZ, Columbia University Medical Center, New York, NY OBJECTIVES: Following vaginal surgery oral and parenteral narcotics are commonly used for pain relief and their use may exacerbate the incidence of sedation, nausea, and vomiting; ultimately delaying convalescence. Previous studies have demonstrated that rectal analgesia following surgery results in lower pain scores and less intravenous morphine consumption (1-2). Belladonna and opium (B&O) rectal suppositories may be used to relieve pain and minimize side effects; however their efficacy has not been confirmed. We aimed to evaluate the use of B&O suppositories for pain reduction in vaginal surgery. MATERIALS AND METHODS: A prospective, randomized, double-blind, placebo-controlled trial using B&O suppositories following inpatient or outpatient vaginal surgery was conducted. Vaginal surgery was defined as: (1) vaginal hysterectomy with uterosacral suspension or (2) post-hysterectomy prolapse repair including uterosacral suspension and/or colporrhaphy. B&O 16A (16.2/60 mg) or placebo suppositories were administered rectally immediately following surgery and every 8 hours for a total of 3 doses. Patient reported pain was collected using a visual analog scale (VAS) at 2, 4, 12, and 20 h postoperatively. Opiate use was measured and converted into IV morphine equivalents. The primary outcome was pain and secondary outcomes included pain medication, antiemetics, and a quality of recovery questionnaire. A priori power analysis aimed for 80% power (a .05) to detect a difference of 2 points. Adverse effects were surveyed at 24 hours and 7 days. Concomitant procedures for urinary incontinence or pelvic organ prolapse did not preclude enrollment. RESULTS: Ninety women were randomized consecutively at a single institution under the care of a fellowship trained surgeon group. Demographics did not differ between the groups with mean age 55, procedure time 97 minutes, and prolapse 51%. Postoperative pain scores were equivalent among both groups at each time interval. The B&O group used a mean of 57 mg morphine compared to 66mg for placebo (p1⁄40.43) in 24 hours. Patient satisfaction with recovery was similar (p1⁄40.59). Antiemetic and ketorolac use were comparable among groups. A subgroup analysis of patients with prolapse did not reveal differences in pain scores. The use of B&O suppositories was uncomplicated and adverse effects were similar among groups including constipation and urinary retention. CONCLUSION: B&O suppositories are safe for use following vaginal surgery. B&O suppositories did not reveal a statistically significant reduction in narcotic use compared to placebo; however the treatment group used fewer narcotics with similar recovery satisfaction which may offer clinical significance and/or reduced healthcare cost. Further investigation is warranted to identify a population that may optimally benefit from B&O use.