Investigating the efficacy of a pulmonary recruitment maneuver and closed drainage in reducing shoulder tip pain in women undergoing a total laparoscopic hysterectomy.

Participants that meet the study exclusion inclusion criteria will be randomised into one of four study groups. Group A - Participants will receive the combined treatment of closed drainage for 4 hours and the pulmonary recruitment maneuver. Group B - Participants will receive the single treatment of closed drainage for 4 hours. Group C - Participants will receive the single treatment of the pulmonary recruitment maneuver plus a sham drain. Group D - Participants will receive the current standard of care (no treatment) plus a sham drain. The method of entry into the patient’s abdomen will be left to the discretion of the surgeon. The maximum number of ports allowed to complete the surgery will be four. Only one 10mm port will be allowed. Intraabdominal pressure during the surgical procedure should not exceed 15mmHg and the maximum flow rate should not exceed 40ml/min. Closed Drain method The drain will be administered by the surgeon. A 15cm Blakes drain will be inserted through one of the existing 5mm port sites at the end of the surgery if the patient is randomized to arm A or B of the study. The drain will be placed on low suction, sutured down at its proximal end and removed 4 hours later by the ward nurse. Patient’s randomized to arm C or D of the study will have a sham drain tube placed beneath a strip of sterile gauze taped to the skin, with no intraperitoneal or subcutaneous insertion and removed 4 hours later by the ward nurse. Documentation will be provided to ward staff to ensure awareness of the presence of the sham drain tube. Pulmonary recruitment maneuver The pulmonary recruitment maneuver will be administered by the anaesthetist. The pulmonary recruitment maneuver will involve a series of positive pressure ventilations after the completion of the laparoscopic procedure. It will be restricted to a maximum of five inflations and to a positive ventilation pressure of 40 mmHg, with the patients placed in the Trendelenburg position (30º) and with the laparoscopic ports left open. Post-operative assessment The surgeon will note in the participant’s medical file that the Visual Analogue Scale (VAS) numerical score and 15-item Quality of Recovery questionnaire (QoR-15) are required to be completed approximately 24-36 hours after the start of the operation. The time of completion of these assessments must be clearly recorded on the assessment sheets. A Study Coordinator will approach the participants the day after their operation to provide them with the VAS and QoR-15 for completion. The Study Coordinator will: •Record the details of consultation, including the time, on the computer data sheet assessment (eCRF). The medical records will be used to assess adherence to the interventions. •Book an appointment for follow-up consultation for 6 weeks’ time.