Following the approval of robotically assisted laparoscopy for gynecology by the Food and Drug Administration in 2005, the procedure assumed an important role in gynecology. It has been generally believed that robotic surgery is clinically superior to video-assisted laparoscopy, causing less postoperative pain and a shorter recovery time. However, few prospective studies have compared conventional laparoscopy with robotic-assisted laparoscopy, and none has focused on differences between these procedures in postoperative pain.
The aim of this prospective nonrandomized study was to compare subjective and objective measures of postoperative pain time between patients undergoing conventional laparoscopy and those undergoing robotic-assisted laparoscopy. Eligible patients were treated at an urban university-affiliated hospital between March 2011 and March 2012.
Subjective postoperative pain was evaluated using the numeric rating scale. Narcotic use was converted to morphine sulfate equivalents. The primary study outcome was the numeric rating scale pain score obtained on the first postoperative day.
Of the 110 patients enrolled: 91 were included in the final analysis and 52 in the laparoscopy group and 39 in the robotic group. Groups were comparable with regard to race, previous abdominopelvic surgeries, psychiatric history, and substance abuse. Patients in the robotic group were 6 years older, and their body mass index was 6 points higher. Median length of hospital stay in the laparoscopic and robotic groups was 2 and 3 days, respectively (P < 0.001). Median time to being off narcotics was 4 days for the laparoscopy group compared with 4.5 days for the robotic group (P = 0.336), and median return to normal activities was 13 and 21 days, respectively (P = 0.021). No significant differences between groups were found in mean numeric rating scale pain scores over time (P = 0.499) or mean narcotic requirements (P = 0.393).
These data suggest that robotically assisted laparoscopy provides no advantages over conventional laparoscopy with respect to postoperative pain and recovery.
Department of Obstetrics and Gynecology, St Luke’s–Roosevelt Hospital Center, New York, NY