Journal of Gynecologic Surgery

We observed at our hospital that patients were using more opioids postoperatively than reported in the literature. We evaluated the efficacy of adding suzetrigine preoperatively to our enhanced recovery after surgery (ERAS) protocol, which utilizes premedication (acetaminophen, celecoxib, and pregabalin), then intraoperative subcutaneous liposomal bupivacaine followed by scheduled oral acetaminophen and ibuprofen postoperatively. Patients also have oxycodone as needed for breakthrough pain. The goal of this quality improvement project was to reduce postoperative opioid use at our hospital by 50%.

We conducted an ambispective quality improvement project that included all patients who underwent total laparoscopic hysterectomy over a 1-year period. We then added suzetrigine to the other routine premedications. Patient medical records were evaluated for demographics, surgical characteristics, opioid type and dose, pain scores, length of stay, and complications. Opioids were converted to oral morphine dose equivalents.

In total, 68 patients were included within the preintervention and after-intervention cohorts. Mean opioid usage was lower in the postintervention group (13.3 mg vs. 28.5 mg, p < 0.001). After intervention, patients were five times more likely to decline opioids (p < 0.001) without any concomitant increase in pain scores. Furthermore, after the intervention, patients were 24 times more likely to be discharged on the day of surgery (p < 0.001).

The addition of suzetrigine to our ERAS protocol was associated with significant reductions in postoperative opioid use and mean pain scores. The quality improvement project met its stated goal of reducing postoperative opioid use by 50%.

To evaluate the effect of structured hands-on simulation training on obstetrics and gynecology (OB/GYN) residents’ knowledge, confidence, and procedural preference for vaginal natural orifice transluminal endoscopic surgery (vNOTES).

This prospective, observational study was conducted between July and August 2022 at a single tertiary medical center. Twelve fourth-year OB/GYN residents completed a didactic online curriculum on adnexectomy and hysterectomy via vNOTES, followed by three monthly hands-on simulation labs using box trainers under direct faculty supervision. Residents’ confidence in key surgical steps and procedural preferences was assessed with pre- and post-simulation surveys. Faculty procedural assessments were recorded for each simulation.

A total of 49 procedural assessments were completed, including 23 adnexectomies and 26 hysterectomy procedures. Competence was achieved in hysterectomy and adnexectomy by 5 out of 12 and 2 out of 12 residents, respectively. Seven residents completed feedback surveys before and after the simulations. Residents reported a 33% increase in confidence performing anterior and posterior colpotomy. Confidence in transecting the uterosacral ligaments increased from 71% to 85% after simulations. Confidence in transecting the uterine artery via vNOTES doubled from 14% to 28% compared with the laparoscopic approach following simulation. Confidence in performing adnexectomy increased by 15% after simulation; however, there was a 14% reduction in the preference for choosing vNOTES for hysterectomy.

Hands-on simulation in vNOTES enhances residents’ knowledge and confidence in performing key surgical steps of adnexectomy and hysterectomy. These findings support the integration of vNOTES simulation into residency training programs to improve surgical proficiency.

The aim of this pilot study is to evaluate the feasibility and clinical outcomes of bilateral salpingectomy performed using the vaginal natural orifice transluminal endoscopic surgery (vNOTES) technique under spinal anesthesia in women requesting permanent contraception.

In this study, bilateral salpingectomy was performed using the vNOTES technique under spinal anesthesia in 12 multiparous patients who requested permanent contraception. Demographic characteristics, surgery duration, intraoperative vital signs, preoperative and postoperative hemoglobin and hematocrit values, pain scores using the visual analog scale (VAS), and postoperative complications were recorded. The Quality of Recovery-15 (QoR-15) recovery questionnaire was administered prior to discharge.

The mean age of the patients was 36.66 ± 5.67 years, and the mean body mass index was 27.33 ± 6.97 kg/m². The mean surgery duration was 25.66 ± 14.55 minutes, and the mean hospital stay was 22.45 ± 3.30 hours. The mean VAS score was 3.83 ± 1.74 at 6 hours postoperatively and 2.23 ± 1.15 at 12 hours postoperatively. Shoulder pain was observed in three patients. No major intraoperative or postoperative complications were observed in any patient. The mean total score on the QoR-15 Recovery Questionnaire was 107.83 ± 15.74.

Bilateral salpingectomy performed with vNOTES under spinal anesthesia appears to be a safe and feasible minimally invasive surgical method in women seeking permanent contraception, offering a short surgical duration, low postoperative pain scores, and a short hospital stay. Prospective studies with larger patient series are needed to validate these findings.