Analysis of postoperative pain in robotic versus traditional laparoscopic hysterectomy
- 298 Downloads
The aim of this study was to assess postoperative pain and narcotic use in the first 23 h following robotic versus traditional laparoscopic hysterectomy for benign pathology. The study design was that of a retrospective case–control study of robotic (first 100 consecutive) versus traditional (last 100 consecutive) total laparoscopic hysterectomy cases at an obstetrics and gynecology multi-institutional community practice. Patient characteristics were equivalent in both groups (age, p = 0.364; body mass index, p = 0.326; uterine weight, p = 0.565), except for a higher number of Caucasians in the traditional laparoscopic group (p = 0.017). Compared to patients who underwent robotic laparoscopic hysterectomy, those who underwent the traditional procedure had higher visual analog scale pain scores (3.1 ± 1.5 vs. 4.6 ± 2.4, respectively; p < 0.001) and used more narcotics (27.5 vs. 35.4 mg hydrocodone, respectively; p < 0.05). Factors that could potentially increase pain (more procedures, more ports, total incision size, and longer operative time) were significantly higher in the robotic group, but only surgical approach, amount of narcotic, and age correlated with pain levels when evaluated with regression analysis. Complication rates were equivalent between groups. In conclusion, patients who underwent robotic assisted laparoscopic hysterectomy had statistically decreased postoperative pain scores and narcotic use than those who underwent the traditional laparoscopic approach, even when the robotic cases involved more procedures and ports and were associated with longer operative time.
Keywordsda Vinci Laparoscopic hysterectomy Minimally invasive surgery Narcotics Pain Robotic
The authors would like to thank April E. Hebert, Ph.D, Scientific Consultant, for manuscript assistance and preparation (paid directly by Dr. Betcher); she also consults for Intuitive Surgical, Inc. the manufacture of the da Vinci Surgical System.
Financial disclosure/conflict of interest
No funding was received for this study. Dr. Betcher proctored for Intuitive Surgical from 2008 to 2012. April E Hebert, Ph.D, Scientific Consultant, provided manuscript assistance and preparation and was paid directly by Dr. Betcher; she also consults for Intuitive Surgical, Inc. the manufacturer of the da Vinci Surgical System.
- 2.Blake J (2004) Hysterectomy quality report: measuring quality at Sunnybrook & Women’s/University of Toronto. In: Women’s Health Conference: Accountability for Excellence. Available at: http://www.ontla.on.ca/library/repository/mon/8000/244055.pdf. Accessed 25 Mar 2012
- 8.Giep BN, Giep HN, Hubert HB (2010) Comparison of minimally invasive surgical approaches for hysterectomy at a community hospital: robotic-assisted laparoscopic hysterectomy, laparoscopic-assisted vaginal hysterectomy and laparoscopic supracervical hysterectomy. J Robot Surg 4:167–175. doi: 10.1007/s11701-010-0206-y PubMedCentralPubMedCrossRefGoogle Scholar
- 10.Kilic GS, Moore G, Elbatanony A, Radecki C, Phelps JY, Borahay MA (2011) Comparison of perioperative outcomes of total laparoscopic and robotically assisted hysterectomy for benign pathology during introduction of a robotic program. Obstet Gynecol Int 2011:683703. doi: 10.1155/2011/683703 PubMedCentralPubMedGoogle Scholar
- 17.Kho RM, Hilger WS, Hentz JG, Magtibay PM, Magrina JF (2007) Robotic hysterectomy: technique and initial outcomes. Am J Obstet Gynecol 197(113):e111–e114Google Scholar
- 22.White MA, Autorino R, Spana G, Laydner H, Hillyer SP, Khanna R, Yang B, Altunrende F, Isac W, Stein RJ, Haber GP, Kaouk JH (2011) Robotic laparoendoscopic single-site radical nephrectomy: surgical technique and comparative outcomes. Eur Urol 59:815–822. doi: 10.1016/j.eururo.2011.02.020 Google Scholar