A Prospective Randomized Trial of Antislip Surfaces During Minimally Invasive Gynecologic Surgery

Abstract

Objective:

The aim of this research was to assess the effectiveness of antislip surfaces for reducing intraoperative patient displacement while in the Trendelenburg position.

Materials and Methods:

A prospective randomized trial was conducted on intraoperative displacement in patients undergoing major laparoscopic or vaginal gynecologic surgery from June 2018 to December 2019. Patients were randomly assigned to 1 of 3 antislip surfaces: pink pad (The Pink Pad XL^®; Xodus Medical Inc., New Kensington, PA), gel pad (Action^® O.R. Overlay; Action Products Inc., Hagerstown, MD), or beanbag (Olympic Vac-Pac^®; Natus Medical Inc., Pleasanton, CA). A total of 161 patients were enrolled, with 148 eligible for analysis. The primary outcome was intraoperative displacement related to the Trendelenburg position. This was assessed by measuring movement at the perineum, anterior superior iliac spine (ASIS), umbilicus, acromion, and head. Secondary measures also assessed included positioning time, postoperative pain, and erythema. A sample size of 50 patients per arm could achieve a >90% power.

Results:

There was significantly less movement on the pink pad at all anatomical landmarks, compared to the gel pad (p ≤ 0.001). The beanbag was equivalent to the pink pad, except at the ASIS (p = 0.008) and perineum (p = 0.022), where it had greater displacement. The most-consistent predictors of movement included: height; weight; and body mass distribution. Obese patients' displacement was 32%–55% greater than the nonobese patients' displacement. The pink pad was 19.2% (p = 0.042) and 30.8% (p < 0.001) faster to position than the gel pad and beanbag, respectively. Postoperative back pain was less on the pink pad, compared to the gel pad (p = 0.036). Postoperative erythema was significantly less common on the pink pad versus the beanbag (6.2% versus 30%, respectively; p = 0.005). There were no differences in complications among the antislip surfaces.

Conclusions:

Patients on the pink pad had significantly less displacement with Trendelenburg and faster positioning, compared to the gel pad. Obesity is a major predictor of movement. The pink pad was associated with less postoperative pain than the gel pad and less postoperative erythema than the beanbag. (J GYNECOL SURG 38:153)