Kobe City Medical Center, West Hospital, 2-4 Ichibancho, Nagata-ku, Kobe, Hyogo, 653-0013, Japan.
Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Honmachi, Sakyo-ku, Kyoto, 606-8501, Japan.
J Robot Surg. 2023 Aug;17(4):1669-1674. doi: 10.1007/s11701-023-01581-3. Epub 2023 Mar 23.
Although robotic and laparoscopic total hysterectomies are widely used as minimally invasive procedures, consensus on which is superior regarding lesser postoperative pain is lacking. This study determines whether there is a difference in the proportion of postoperative use of non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen between robotic and laparoscopic total hysterectomies. This retrospective cohort study enrolled patients who underwent robotic or laparoscopic total hysterectomy for uterine fibroids, adenomyosis, or cervical intraepithelial neoplasia grade 3 at a hospital between July 2016 and November 2021. The outcome was postoperative analgesics (i.e., NSAIDs or acetaminophen) use. Unadjusted and adjusted logistic regression analyses were performed to evaluate the association between the procedure and outcome. Adjusted variables were age, body mass index, surgeon's laparoscopic technique certification, intravenous patient-controlled analgesia, and wound local anesthesia. Of 127 patients, 3 were excluded, and 124 were included. Robotic and laparoscopic hysterectomy was performed in 38 and 86 patients, respectively. Postoperative analgesics were administered to 10 (26.3%) and 52 (60.5%) patients in the robotic and laparoscopic groups, respectively. Unadjusted logistic regression analysis showed significantly more frequent analgesics use in the laparoscopy group (odds ratio [OR] 4.28; 95% confidence interval [CI] 1.85-9.93; p < 0.01). Adjusted logistic regression analysis did not detect significant differences (OR 2.62; 95% CI 0.91-7.56; p = 0.07). No significant difference in the proportion of postoperative analgesia was observed between robotic total hysterectomy and laparoscopy. Future studies must include larger sample sizes and aligned intraoperative and postoperative analgesic management.
虽然机器人辅助和腹腔镜全子宫切除术已广泛应用于微创手术，但对于哪种手术术后疼痛更小，目前尚未达成共识。本研究旨在确定机器人辅助和腹腔镜全子宫切除术之间在术后使用非甾体抗炎药（NSAIDs）和对乙酰氨基酚的比例是否存在差异。
这是一项回顾性队列研究，纳入了 2016 年 7 月至 2021 年 11 月期间在一家医院因子宫肌瘤、子宫腺肌病或宫颈上皮内瘤变 3 级行机器人或腹腔镜全子宫切除术的患者。主要结局为术后使用镇痛药物（即 NSAIDs 或对乙酰氨基酚）的情况。采用未调整和调整后的逻辑回归分析来评估手术方式与结局之间的关联。调整变量包括年龄、体重指数、外科医生的腹腔镜技术认证、静脉自控镇痛和切口局部麻醉。
在 127 例患者中，有 3 例被排除，124 例患者纳入分析。分别有 38 例和 86 例患者接受了机器人和腹腔镜全子宫切除术。机器人组和腹腔镜组分别有 10（26.3%）和 52（60.5%）例患者使用了术后镇痛药。未调整的逻辑回归分析显示，腹腔镜组患者使用镇痛药的频率显著更高（比值比 [OR] 4.28；95%置信区间 [CI] 1.85-9.93；p<0.01）。调整后的逻辑回归分析未发现显著差异（OR 2.62；95% CI 0.91-7.56；p=0.07）。机器人全子宫切除术与腹腔镜手术相比，术后使用镇痛药物的比例无显著差异。未来的研究必须纳入更大的样本量，并在术中及术后采用一致的镇痛管理。
