This review specifically highlighted the reduced selleck chem Imatinib need for analgesia among women as one of the benefits of laparoscopic surgery [14, 17]. Besides the specific evidence related to endometrial cancer surgery to which the present study adds, there is also evidence that analgesic requirements and pain are reduced when minimally invasive surgery is applied to other gynaecological malignant conditions [11, 12] and are also less for women undergoing laparoscopic surgery for benign gynaecological conditions compared with an open surgical approach [10, 20]. For example, a review article examining surgical treatment for obese women with endometrial, cervical, and ovarian cancer found evidence that laparoscopic surgery was associated with less postoperative pain compared with open surgery [9].

Strengths of the present study include the fact that analgesic prescription can be compared between treatment arms within the context of a randomised clinical trial, a long follow-up period, distinction between different analgesic classes, inclusion of pain score comparisons, and the fact that a lower conversion rate than previous trials allows clearer inferences to be made regarding treatment arms. Limitations include the fact that the trial was unblinded, biasing decision-making for epidural and analgesic prescription. In summary, the results of this study show that laparoscopic surgery for endometrial cancer is associated with less need for epidural and postoperative analgesic prescription compared with open surgery, saving on costs of analgesia and highlighting a further significant benefit to patients and the healthcare system of laparoscopic treatment over traditional open abdominal surgery.

Acknowledgments The authors thankfully acknowledge Drs. Sue Lawrence and Hau Tan for their assistance with analgesic classification and comments on previous versions of this paper.
We carried out in our department of gynecology and obstetrics (Foch Hospital, Suresnes, France) a 2-year prospective study, from March 2010 to March 2012. All hysterectomies done for benign gynecological disease were included: 60 RH and 34 VH. Patients’ demographics and medical characteristics were collected from the medical files: age, BMI, surgical indication, surgical history, menopausal status, and hormone replacement therapy were studied, as well as operative time, docking time, anesthesia, uterine weight, blood loss, transfusions, conversion to laparotomy, intra- and postoperative complications, and pre- and postoperative hemoglobin.

Two operators performed the RH and seven the VH. VH procedures were conventionally carried out with vicryl Entinostat ligatures; RH procedures were performed using a uterine manipulator, and vaginal suturing was done using vicryl 1 continuous or interrupted sutures. A questionnaire was completed by all patients postoperatively, aimed to evaluate their pain at D0, D1, D2, and D3 using a visual analog rating 0�C10 scale.