Every Inch Counts: A Prospective Randomized Trial of Anti-Slip Surfaces in Minimally Invasive Gynecologic Surgery

Study Objective To assess the effectiveness of common anti-slip surfaces on reducing intra-operative patient displacement while in Trendelenburg Design Prospective randomized controlled trial with a minimum 6-week post-operative follow up Setting Patient positioning with Trendelenburg Patients or Participants Patients undergoing major laparoscopic or vaginal surgery (hysterectomy or surgery >2 hours) were randomly assigned to one of three anti-slip surfaces: Pink Pad, Action O.R. Overlay (gelpad) or Olympic Vac-Pac (beanbag) from 6/2018-12/2019. 159 patients were enrolled with 148 found to be eligible. Interventions Patients were randomized 1:1:1 one of the three anti-slip surfaces. Measurements and Main Results Patients were pre-operatively assigned to one of three anti-slip surfaces. Intra-operative displacement was assessed by measuring multiple anatomic landmarks [perineum, anteriorsuperior iliac spine (ASIS), umbilicus, acromion and the head] at three times during the case: 1) pre-op, 2) when placed in Trendelenburg, and 3) prior to leveling. Positioning time and time added due to obstructed uterine manipulation were recorded. There was significantly less total movement on the Pink Pad at all anatomic landmarks compared to the gelpad (2.75-5.66cm) and for the torso (ASIS & perineum) compared to the beanbag (1.22-2.69cm). The most consistent predictors of movement included: height, weight, and body mass distribution. Obesity increased displacement by 32-55%. Surgery type, length of surgery, and maximum Trendelenburg did not predict displacement. Laparoscopic surgery with robotic assistance had greater displacement than without (p Conclusion Patients on the Pink Pad had significantly less displacement with Trendelenburg and faster positioning compared to the other surfaces. Obesity is a major predictor of movement. Uterine manipulation was easier on the Pink Pad than the beanbag.