Title: Comparative Analysis of Spinal Anesthesia Versus General Anesthesia in Single-Port
Access Laparoscopic Adnexal Surgery: A Propensity Score Matching Study
Version: 2 Date: 06 Jan 2025
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: Major revision is needed.
REQUESTED REVISIONS:
1. In the method
Clearly define when data points were recorded historically (e.g., “pain scores and PONV were
recorded at 0, 2, 6, 12, 24, and 48 hours postoperatively as part of routine clinical practice”).
Specify the period during which eligible cases were identified (e.g., "Patients who underwent
surgery from January 2020 to December 2022 were included").
Data were extracted from electronic health records, including demographic information,
intraoperative parameters, and postoperative outcomes.
Add a clear explanation of the criteria for initiating PCA, such as specific pain thresholds (e.g.,
VAS > 5) or postoperative conditions that necessitated its use
2. In the result
I am wander about "The ambulation time of approximately 17 hours postoperatively may
coincide with nighttime hours for surgeries performed earlier in the day.
"The difference in hospital stay between the SA and GA groups (2.29±0.56 days vs. 2.71±1.11
days, p=0.046) was statistically significant. However, the reduction of approximately 10 hours
may have limited clinical impact on patient recovery or overall healthcare resource utilization.
Further studies could explore whether such differences influence long-term outcomes or cost-
effectiveness."
Please revise "The immediate postoperative pain levels exhibited a notable disparity, with the
GA group reporting significantly lower pain scores (0.67±0.66) than the SA group (4.74±1.48)
(p<.001)."
SA and Precedex together increase the risk of hypotension and bradycardia through sympathetic
blockade (SA) and central #2-receptor activation (Precedex). Monitoring trends in BP and HR
could clarify whether these effects are compounded or manageable with standard interventions
(e.g., fluid loading or vasopressors).
"Although hypotension was recorded in both groups (SA: 33.3%, GA: 28.6%), detailed
monitoring of blood pressure (BP) and heart rate (HR) trends during the intraoperative period
could provide a more comprehensive understanding of the hemodynamic effects associated with
spinal anesthesia and dexmedetomidine use.
3. In the discussion
Address how the use of dexmedetomidine in the SA group likely reduced PCA. requirements,
as this could be a confounding factor.
The manuscript should reference the meta-analysis titled "Spinal Anesthesia versus General
Anesthesia in Gynecological Laparoscopic Surgery: A Systematic Review and Meta-
Analysis" (DOI: 10.1159/000521364), and “Laparoscopic surgery for benign adnexal conditions
under spinal anaesthesia: Towards a multidisciplinary minimally invasive approach. J Gynecol
Obstet Hum Reprod. 2020 Sep;49(7):101813. doi: 10.1016/j.jogoh.2020.101813. Epub 2020
May 16. PMID: 32426576; PMCID: PMC7229474” as it is directly relevant to the study topic.
Incorporating it strengthens the context and demonstrates awareness of prior research.
In the discussion, "The first investigation into the safety profile of SA in SPA laparoscopy
within the field of gynecology.", this statement is too broad and potentially inaccurate, given the
existence of prior research (e.g., the meta-analysis). While your study may have unique aspects
(e.g., focus on SPA laparoscopy or specific methodologies such as combined with precedex),
claiming it as the first investigation requires justification.
Line 320-322, for a retrospective study, the discussion should emphasize the observational
nature and data constraints, rather than focusing on the selection process as a limitation of the
study design.
Line 330, Specifically, the SA group received dexmedetomidine as part of their postoperative
analgesia regimen. If dexmedetomidine was continued postoperatively, this should be explicitly
stated in the Methods and Results sections. Provide details about the duration, dosage, and
rationale for its postoperative use.
Minor issue
Conduct a thorough review to identify instances where "General Anesthesia" and "Spinal
Anesthesia" are used without abbreviations after being defined.
ADDITIONAL REQUESTS/SUGGESTIONS:
I am wander this is a retrospective study.