ArticleBMC anesthesiology2026
Impact of Trendelenburg angle on perioperative outcomes during gasless vNOTES surgeries: a retrospective comparative study.
Article in BMC anesthesiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThis retrospective cohort study compares perioperative outcomes of reduced Trendelenburg positioning (≤ 20°) versus conventional steep angles (≥ 30°) in gasless vNOTES for benign gynecologic conditions.
methodsOf 102 enrolled patients, 52 were assigned to the Low-Angle Group (Trendelenburg angle ≤ 20°, mean 20.1°) and 50 to the Steep-Angle Group (≥ 30°, mean 30.8°).”Primary outcomes included hemodynamics, airway pressure, and conversion rates; secondary outcomes encompassed operative metrics, anesthetic consumption, and 24-h visual analog scale (VAS) pain scores.Statistical analyses utilized longitudinal mixed models and t-tests.
resultsThe estimation results showed that there is no statistically significant difference between the Low-Angle Group and the Steep-Angle Group in terms of HR, DBP, SBP and airway pressure at different time point during surgery. Airway pressures maintained strict proportionality to tidal volumes in both groups (12–17 cmH2O, p = 0.72).No significant differences were found between groups in conversion rates (4.0% vs. 4.3%, p = 0.319), operative/anesthesia duration, blood loss, complications, or most recovery indicators. Anesthetic consumption and VAS scores for shoulder pain/postoperative nausea and vomiting (PONV) were also similar at 2 h and 24 h. The Low-Angle Group had significantly lower 24-h abdominal pain VAS (0.46 ± 0.28 vs. 1.12 ± 0.42, p = 0.014), exceeding minimal clinically important difference (MCID) thresholds.
conclusionPerforming gasless vNOTES with ≤ 20° Trendelenburg achieves outcomes equivalent to ≥ 30°, including surgical exposure and safety, while significantly reducing postoperative abdominal pain. This challenges the need for routine steep positioning, establishing ≤ 20° as a viable patient-centered standard, offering equivalent efficacy with less discomfort. Further validation warranted.
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