Surgical Condition Evaluation Protocol

Primary outcomes included acceptable surgical condition, surgical condition score, intraoperative movement, and adverse events. Secondary outcomes included additional measures to improve the surgical condition, intraoperative blood loss (mL), duration of surgery (min), pain at 24 h, pain at 48 h, and length of stay (d).
The definitions are as follows: (1) Surgical condition score: Surgical condition scales based on the subjective judgment of the surgeon were commonly used to evaluate the surgical workspace condition, including the 5-point scale (optimal = 5, good but not optimal = 4, moderate = 3, poor but not optimal = 2, poor, and unacceptable = 1) [19 (link)], and the 4-point scale (excellent = 1, good but not optimal = 2, poor but acceptable = 3, unacceptable = 4) [20 (link)]. According to the method of the published research, we converted the 4-point scale to a 5-point scale so that we could pool data in the meta-analysis [8 (link)–11 (link)]. (2) Acceptable surgical condition: Based on surgical condition scales, excellent, optimal, or good but not optimal surgical conditions are not generally thought to interfere with surgical procedures. Therefore, we defined that acceptable surgical condition includes excellent, optimal, and good but not optimal surgical conditions. (3) Intraoperative movement: body movement during surgery. (4) Adverse event: intraoperative and postoperative complications that may be associated with interventions. (5) Additional measures to improve the surgical condition: measures that can improve the surgical condition, including the use of additional NMBAs, changing body position, increasing pneumoperitoneum pressure, and switching to open surgery. (6) Intraoperative blood loss: blood loss during surgery. (7) Duration of surgery: the length of time that surgery continues. (8) Pain: score of the visual analog scale (VAS) or numerical rating scale (NRS), which is converted to a 1–10 range. (9) Length of stay: hospital stays after surgery.