Majeed Amer, Abdelgadir Noon E, AlFattani Areej A G, Hafeez Muhammad, Jahangir Muhammad A, Nagy Mohamad S
Department of Abdominal Transplant Anesthesia, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Pregraduation Intern, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Saudi J Anaesth. 2025 Jan-Mar;19(1):14-20. doi: 10.4103/sja.sja_415_24. Epub 2025 Jan 1.
Acute post-surgical pain is a common concern for patients undergoing living donor hepatectomy (LDH), potentially leading to unfavorable outcomes if not treated adequately. This study aimed to evaluate the impact of the transition of surgical techniques from open and laparoscopic to robot-assisted minimally invasive surgical (MIS) approach, and the different types of graft resection, including right, left, and left lateral partial lobectomy (LL), on analgesia requirements during the first two postoperative days.
A single-center retrospective electronic chart review of all patients who underwent LDH procedures between 2018 and 2020 was performed.
Patients underwent LDH procedure ( = 414) through open ( = 93, 22%), laparoscopic ( = 68, 16%), or robot-assisted MIS ( = 253, 61%) approaches; and had right lobectomy ( = 215, 52%), left lobectomy ( = 121, 29%), or LL ( = 78, 19%). Postoperatively within the first 48 h, the pain reported on a 3-point Visual Analogue Scale (VAS), was mild 77%, moderate 21%, or severe only 2%. The laparoscopic approach and LL resection were associated with higher pain scores, whereas the robotic approach was the least painful overall.
Robot-assisted MIS approach for LDH procedure resulted in lower acute pain scores when compared with other surgical approaches, obviating the need for intravenous (IV) patient-controlled analgesia (PCA).
急性术后疼痛是活体供肝肝切除术（LDH）患者普遍关注的问题，如果治疗不充分可能导致不良后果。本研究旨在评估手术技术从开放手术和腹腔镜手术向机器人辅助微创手术（MIS）方法的转变，以及不同类型的移植物切除术，包括右半肝、左半肝和左外叶部分肝切除术（LL），对术后前两天镇痛需求的影响。
对2018年至2020年间接受LDH手术的所有患者进行单中心回顾性电子病历审查。
患者通过开放手术（n = 93，22%）、腹腔镜手术（n = 68，16%）或机器人辅助MIS手术（n = 253，61%）进行LDH手术；并接受了右半肝切除术（n = 215，52%）、左半肝切除术（n = 121，29%）或LL切除术（n = 78，19%）。术后48小时内，根据3分视觉模拟量表（VAS）报告的疼痛情况为轻度占77%，中度占21%，重度仅占2%。腹腔镜手术方法和LL切除术与较高的疼痛评分相关，而机器人手术方法总体上疼痛最轻。
与其他手术方法相比，机器人辅助MIS方法进行LDH手术导致急性疼痛评分更低，无需静脉注射（IV）患者自控镇痛（PCA）。
