Molinaro Francesco, Krasniqi Pranvera, Scolletta Sabino, Giuntini Laura, Navarra Cristina, Puzzutiello Rosa, Fusi Giulia, Angotti Rossella, Bindi Edoardo, Zanaboni Clelia, Messina Mario, Mattioli Girolamo
Department of Medical Sciences, Surgery and Neuroscience, Section of Pediatric Surgery, Policlinico Le Scotte, University of Siena, Viale Bracci 14, 53100, Siena, Italy.
Unit of Resuscitation, Critical Care, Anesthesia and Intensive Care, University Hospital of Siena, Siena, Italy.
J Robot Surg. 2020 Jun;14(3):423-430. doi: 10.1007/s11701-019-01005-1. Epub 2019 Jul 24.
In the last decade, the applicability of robotic surgery has been demonstrated in many interventions, expanding the indications of minimally invasive surgery also to pediatrics. The aim of the study is to evaluate postoperative pain to demonstrate better control following robotic procedures compared to thoraco-laparoscopic surgery. An observational, retrospective, multicentre study was performed involving 204 children undergoing robot-assisted surgery and thoraco/laparoscopic surgery at the Istituto Giannina Gaslini in Genoa and the Siena University Hospital (2013-2017): 83 children underwent robotic-assisted surgery and 121 thoracic-laparoscopic surgery. Personal data and type of intervention were assessed, dividing the patients into four categories: thoracic, gastrointestinal, hepatobiliary and urological surgeries. We analyzed the anesthetic risk according to ASA classification by type of intervention, the type of anesthesia used, the anesthetic drugs used during surgery and in the postoperative period. Both the problems that occurred during the procedures and the number of interventions converted into open during robotic surgery and laparoscopic thoracic surgery were analyzed. Pain was measured on the 1st, 2nd and 3rd day (FLACC or NRS scales). By comparing the two groups (robotics-non-robotics), the analysis shows that postoperative pain does not change with the chosen approach, but always maintains very low values, typical of minimally invasive surgery. The pain score is significantly higher in patients undergoing thoracic surgery, either robotic or thoracoscopic, compared to those undergoing gastrointestinal surgery (P corrected according to Bonferroni: 0.0006) and those undergoing urological intervention (P corrected according to Bonferroni: 0.04). In conclusion, no significant change in the intensity of postoperative pain between the two groups was found, while it is seen that the pain in patients undergoing thoracic interventions (robotic/thoracoscopic) is more intense than that reported for other types of interventions.
在过去十年中，机器人手术的适用性已在许多干预措施中得到证实，将微创手术的适应症扩展到了儿科领域。本研究的目的是评估术后疼痛情况，以证明与胸腔镜-腹腔镜手术相比，机器人手术术后能更好地控制疼痛。我们进行了一项观察性、回顾性、多中心研究，纳入了204例在热那亚的吉安尼娜·加斯利尼研究所和锡耶纳大学医院接受机器人辅助手术和胸腔镜/腹腔镜手术的儿童（2013 - 2017年）：83例儿童接受了机器人辅助手术，121例接受了胸腔镜-腹腔镜手术。评估了个人数据和干预类型，将患者分为四类：胸科、胃肠、肝胆和泌尿外科手术。我们根据ASA分类，按干预类型、所用麻醉类型、手术期间及术后使用的麻醉药物分析了麻醉风险。分析了手术过程中出现的问题以及机器人手术和胸腔镜手术中转开腹手术的干预次数。在第1、2和3天使用FLACC或NRS量表测量疼痛程度。通过比较两组（机器人手术组-非机器人手术组），分析表明，术后疼痛程度不会因所选手术方式而改变，但始终保持在微创手术特有的非常低的水平。与接受胃肠手术的患者相比（根据Bonferroni校正后的P值：0.0006）以及与接受泌尿外科手术的患者相比（根据Bonferroni校正后的P值：0.04），接受胸科手术（无论是机器人手术还是胸腔镜手术）的患者疼痛评分显著更高。总之，未发现两组术后疼痛强度有显著变化，然而可以看出，接受胸科手术（机器人手术/胸腔镜手术）的患者的疼痛比其他类型手术的患者更剧烈。
