Effects of Virtual Reality on Postoperative Pain Management Following Minimally Invasive Gynecologic Surgery: Randomized Controlled Trial

Clinical Snapshot

Key Findings

• P Value: Primary outcome P=.45; maximum pain score P=.08; anxiety score P=.84; all secondary outcomes (length of stay, costs, adverse events) P>.05

• Effect Size: Mean difference 0.169 VAS points (VR vs. control); well below the accepted MCID of 1.0–1.3 points on a 0–10 VAS scale

• Primary Outcome: Change in VAS pain score between 6 and 7 hours postoperatively: no statistically significant difference between VR and control groups

• Nnt Or Sensitivity: NNT not calculable given absence of clinically significant or statistically significant benefit; no threshold for meaningful pain reduction was met in either group comparison

• Confidence Interval: 95% CI -0.271 to 0.608 for primary outcome; 95% CI -0.101 to 1.779 for maximum pain score; 95% CI -0.365 to 0.449 for anxiety score change

Clinical Application

VR headsets require capital investment, infection-control protocols (particularly in surgical ward environments), staff training, and patient selection (contraindications include motion sickness susceptibility, epilepsy, and certain visual impairments). A single 20-minute session is logistically feasible but the evidence base does not currently support implementation as a standard adjunct. In Australia, minimally invasive gynaecologic surgery is widely performed across public and private hospital settings. Multimodal analgesia consistent with RACGP and ANZCA acute pain guidelines is standard of care. VR is not currently listed on the PBS or endorsed by TGA as a therapeutic device for postoperative pain. The Therapeutic Goods Administration classifies VR headsets used for therapeutic purposes as medical devices requiring appropriate registration. Australian hospitals considering VR adoption would need to address Therapeutic Goods Act compliance, infection prevention standards (Reprocessing of Reusable Medical Devices), and cost-effectiveness evaluation within Activity Based Funding frameworks. This trial does not provide sufficient evidence to support a business case for VR adoption in Australian gynaecologic surgical units at this time. Adult women undergoing elective minimally invasive gynaecologic surgery (laparoscopy, hysteroscopy) for benign conditions with standard postoperative pain management protocols

Abstract

BACKGROUND: Postoperative pain and anxiety remain common concerns after minimally invasive gynecologic surgery despite advances in surgical techniques and analgesic strategies. Virtual reality (VR) has been investigated as a potential nonpharmacological intervention for pain management; however, evidence in gynecologic postoperative settings is limited. OBJECTIVE: This study aims to evaluate the efficacy and safety of VR technology compared with standard postoperative analgesia for pain and anxiety management in patients undergoing minimally invasive gynecologic surgery. METHODS: This randomized controlled trial was conducted at Sun Yat-sen Memorial Hospital of Sun Yat-sen University in China. A total of 131 patients undergoing laparoscopy or combined hysteroscopy for benign gynecologic diseases were randomly assigned in a 1:1 ratio to either a VR group (n=68) or a control group (n=63). All patients received a standardized general anesthesia protocol intraoperatively. The control group received conventional analgesic therapy after surgery, and the VR group received a 20-minute VR intervention 6 hours postoperatively. The pain and anxiety levels were evaluated using a visual analog scale at 6 and 7 hours postoperatively. The primary outcome was the change in pain scores between 6 and 7 hours. Secondary outcomes included maximum pain score, anxiety score changes, length of hospital stay, hospitalization costs, and occurrence of adverse events. Analyses were performed according to the intention-to-treat principle. RESULTS: There was no statistically significant difference in the primary outcome between the VR and control groups (mean difference 0.169, 95% CI -0.271 to 0.608; P=.45). Similarly, no significant differences were observed in the maximum pain score (mean difference 0.839, 95% CI -0.101 to 1.779; P=.08), and no improvement was observed in the anxiety score (mean difference 0.042, 95% CI -0.365 to 0.449; P=.84). No significant differences were found in length of hospital stay, hospitalization costs, or incidence of adverse events, including dizziness, nausea, and vomiting (all P>.05). CONCLUSIONS: A single 20-minute VR intervention did not provide additional analgesic or anxiolytic benefit compared with standard postoperative care after minimally invasive gynecologic surgery. VR was well tolerated, and its role in postoperative recovery requires further investigation. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2400091244; https://tinyurl.com/4b92a9td.

References

1. 1.Hu, Q., Chen, L., Zhu, Y., Xiang, T., Liang, X., Wu, G., Ding, M., & Long, T. (2026). Effects of virtual reality on postoperative pain management following minimally invasive gynecologic surgery: Randomized controlled trial. JMIR Formative Research. https://doi.org/10.2196/92442