Betcher Raymond E, Chaney James P, Lacy Pamela R, Otey Stephen K, Wood Duke J
Physicians and Surgeons Clinic, Obstetrics and Gynecology, Baptist Memorial Hospital-Golden Triangle, 225 Baptist Blvd., Columbus, MS, 39705, USA.
Physicians and Surgeons Clinic, Obstetrics and Gynecology, Gilmore Memorial Regional Medical Center, 900 Earl Frye Blvd, Amory, MS, 38821, USA.
J Robot Surg. 2014 Mar;8(1):35-41. doi: 10.1007/s11701-013-0418-z. Epub 2013 Jul 3.
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.
本研究旨在评估机器人辅助与传统腹腔镜子宫切除术治疗良性病变后23小时内的术后疼痛及麻醉药物使用情况。本研究设计为一项回顾性病例对照研究，对比了某妇产科多机构社区诊所中机器人辅助（连续前100例）与传统（连续后100例）全腹腔镜子宫切除术病例。两组患者的特征相当（年龄，p = 0.364；体重指数，p = 0.326；子宫重量，p = 0.565），但传统腹腔镜组的白种人数量更多（p = 0.017）。与接受机器人辅助腹腔镜子宫切除术的患者相比，接受传统手术的患者视觉模拟评分法疼痛评分更高（分别为3.1±1.5和4.6±2.4；p < 0.001），且使用的麻醉药物更多（分别为27.5和35.4毫克氢可酮；p < 0.05）。机器人辅助组中可能增加疼痛的因素（更多手术步骤、更多穿刺孔、总切口大小及更长手术时间）显著更高，但在进行回归分析时，只有手术方式、麻醉药物用量和年龄与疼痛程度相关。两组并发症发生率相当。总之，接受机器人辅助腹腔镜子宫切除术的患者术后疼痛评分和麻醉药物使用量在统计学上低于接受传统腹腔镜手术的患者，即使机器人辅助手术的病例涉及更多手术步骤和穿刺孔且手术时间更长。
