Strength and limitations
Although we are fully aware that no other studies like randomized controlled trials can minimize bias and provide a rigorous tool to examine cause-effect relationships between intervention and outcome, our study was conceived and designed as a prospective study. We believe, indeed, that patient’s motivation and willingness to accomplish surgery under RA are key aspects for the accomplishment of the procedure therefore, in our opinion, randomization of patients at the moment has to be considered counterintuitive and challenging.
Strengths of our study were the sample size (the largest reported so far in literature), the accomplishment of all the procedures by one skilled surgeon and the assessment of the tolerability and the evaluation of the pain during each step of laparoscopy (in order to determine the acceptability of the procedure when performed under regional anesthesia). We consider this latter of paramount importance based on the assumption that sedation should be avoided as much as possible to preserve spontaneous breathing already restricted by the level of neuraxial anesthesia and Trendelenburg’s position.