12057 Surgical Stress-Buster: Dexamethasone's Role in Robotic Hysterectomy

Minimally invasive surgery has revolutionized the field of surgical interventions with its numerous advantages such as reduced postoperative pain, faster recovery, and shorter hospital stays. The anti-inflammatory effects of dexamethasone is well documented; evoking interest in studies on the potential benefit in surgical procedures. Numerous studies have investigated the use of dexamethasone in the context of laparoscopic surgery but less so in the gynecologic robotic field. We evaluated of the effect of 24 mg dexamethasone on surgical stress, pain and recovery in robotic hysterectomy. We performed the first ever double-blinded randomized study on dexamethasone in benign robotic hysterectomy (NCT04762381). Blood sampling and visual analog scale (VAS) for pain and medications and sexuality and incontinence were obtained. Women scheduled for benign robotic hysterectomy in hospital setting. Women with benign indication for hysterectomy excluding co-morbidities diabetes, malignant disease or chronic pain. In 2022-24 women were randomized to a single dose of either saline (n=58) or 24 mg dexamethasone (n=51) 15 minutes before surgery. 109 women had complete blood sampling at all-time points. Their average age was 48 years (range 23-75), parity 1.6 (0-2), BMI 29 kg/m2 (18-44), and 17 were current users of estrogen. The VAS was 0.5 (0-5) at baseline and 2.3 (0-10) 24 h after operation, similar in both groups. The c-reactive protein was significantly lower in the dexamethasone group at 12h 7.5 mg/L (95% CI; 5.7-9.2) vs. 11.5 (95% CI;9-14) in controls. Similarly, at 24h 19.7 (13-27) vs. 48.8 (39-59) in the dexamethasone group vs. controls. At present, no difference between the groups is found in the questionnaires on recovery and symptoms. The effect of dexamethasone on c-reactive protein indicating a reduction of the perceived surgical stress response. Further results and in particular, those of the underlying response modulators will be presented.