Postoperative Pain Medication Requirements in Patients Undergoing Computer-Assisted (“Robotic”) and Standard Laparoscopic Procedures for Newly Diagnosed Endometrial Cancer

Abstract

RBT is independently associated with significantly lower postoperative pain and pain medication requirements compared to LSC. The amount of intraoperative fentanyl analgesia does not appear to correlate with postoperative pain.Endometrial cancer is the most common gynecologic malignancy in the United States, with an estimated 47,130 new cases in 2012.1 An estimated 287,100 women were diagnosed with endometrial cancer worldwide in 2008.2 Surgery is the primary treatment of choice for the majority of these women.3 The standard surgical approach has been total abdominal hysterectomy, bilateral salpingo-oophorectomy, and staging via laparotomy. Multiple retrospective series have shown that a less invasive surgical approach via laparoscopy (LSC) is feasible and safe, and also associated with improved perioperative outcomes compared to laparotomy in these patients.4 The Gynecologic Oncology Group (GOG) published results of the largest randomized trial (LAP2) comparing LSC to laparotomy in patients with newly diagnosed endometrial carcinoma in 2009.5,6 This landmark study essentially changed the accepted standard surgical approach in this group. Postoperative complications, median blood loss, and median length of stay (LOS), despite increased operative time, were significantly lower in LSC patients despite 25 % requiring conversion to laparotomy.5 The first 802 eligible patients randomized in LAP2 also participated in a quality-of-life (QOL) study. Within 6 weeks of surgery, patients assigned to LSC reported significantly better QOL on all scales other than fear of recurrence.6 Overall, during this 6-week postoperative period, patients assigned to LSC had superior QOL, fewer physical symptoms, less pain and pain-related interference with functioning, better physical functioning and emotional state, earlier resumption of normal activities, earlier return to work, and better body image compared to those assigned to laparotomy.6 Recurrence-free and overall survivals were the same in both groups.7 Multiple published retrospective series have shown possible benefits, such as reduced postoperative pain, using the robotic (RBT) platform compared to LSC or laparotomy in patients with endometrial cancer.8-11 In a randomized trial, LSC was found to be associated with less postoperative pain compared to vaginal approaches in patients undergoing hysterectomy for benign gynecologic disease.12 A small retrospective series reported further reductions in postoperative pain in patients who had undergone an RBT hysterectomy compared to a standard total LSC hysterectomy for benign indications.13 A recent cost analysis suggested that patients experienced less pain and required less pain medication use after RBT procedures compared to LSC for endometrial cancer.14 Based on these reports, we sought to analyze postoperative pain and the use of pain medication in patients undergoing RBT compared to standard transperitoneal LSC procedures for newly diagnosed endometrial cancer during a concurrent time period. Of note, current RBT surgery is not...

Prospective cohort study comparing quality of life and sexual health outcomes between women undergoing robotic, laparoscopic and open surgery for endometrial cancer

“…Single arm cohort studies examining QOL in patients undergoing robotic surgery have shown that there is a return to baseline scores by three to five weeks, suggesting an advantage to this modality over laparoscopy [27,28]. One retrospective study reported reduced pain medication requirements in women treated with a robotic versus laparoscopic approach [29]. However, there have been no prospective studies directly comparing laparoscopic and robotic surgical patients for overall QOL.…”

Comparison of robotic approach, laparoscopic approach and laparotomy in treating epithelial ovarian cancer

“…Regarding the postoperative outcomes, the robotic group demonstrated significantly lower postoperative and 24 h pain scores. Previous reports had demonstrated that anaesthetic requirements were lower during robotic surgery for cervical and endometrial cancer management, which corresponded to our results . A possible explanation is that robotic surgery provided precise dissection within a limited space and reduced the need for local electro‐coagulation during surgery; as a result, tissue damage was reduced.…”

Ultrasound-Guided Subcostal Transversus Abdominis Plane Infiltration With Liposomal Bupivacaine for Patients Undergoing Robotic-Assisted Hysterectomy

“…Leitao and colleagues (2013) showed that patients undergoing robotic surgery for endometrial cancer had a median maximal pain score of 4 and median total post-operative fentanyl use of 242.5 micrograms. (12) Hachem et al (2013) showed that patients who underwent robotic hysterectomy had a mean pain score of 6.62 on post-operative day (POD) 0 and 5.59 on POD 1. (13) While no studies have evaluated a TAP block's effectiveness in robotic assisted hysterectomy, there have been studies evaluating its use in laparoscopic assisted total hysterectomy with conflicting reported benefits.…”