title: Postoperative pain and recovery after conventional laparoscopy compared with robotically assisted laparoscopy.
abstract: OBJECTIVE
  To compare postoperative pain after conventional laparoscopic and robotically assisted laparoscopic surgery in gynecology.
  
  
  METHODS
  This is a prospective nonrandomized analysis of patients undergoing conventional laparoscopy or robotically assisted laparoscopy in a university-affiliated hospital between March 2011 and March 2012. Postoperative pain was measured using the Numeric Rating Scale and the narcotic use converted to morphine sulfate equivalents. The primary outcome was the Numeric Rating Scale pain score obtained on the first postoperative day.
  
  
  RESULTS
  One hundred ten patients were enrolled; 91 were included in the statistical analysis. Both groups were similar with regard to race, history of abdominopelvic surgeries, psychiatric history, and substance abuse. Patients undergoing robotically assisted laparoscopy were 6 years older and had a body mass index 6 points higher. Median length of hospital stay for conventional laparoscopy and robotically assisted laparoscopy was 2 days and 3 days, respectively (P<.001); median to being off narcotics was 4 days and 4.5 days, respectively (P=.336); and median return to normal activities was 13 days and 21 days, respectively (P=.021). There were no significant differences in mean Numeric Rating Scale pain scores over time (P=.499) or mean narcotic requirements (P=.393) between groups.
  
  
  CONCLUSIONS
  Robotically assisted laparoscopy is equivalent to conventional laparoscopy in terms of subjective and objective measures of postoperative pain.
authors: Department of Obstetrics and Gynecology, St. Luke's-Roosevelt Hospital Center, New York, New York.
authors: Lena El
authors: LE
authors: Hachem
authors: Uchenna C
authors: UC
authors: Acholonu
authors: Farr R
authors: FR
authors: Nezhat
mesh_terms: D000328:Adult; D000368:Aged; D000698:Analgesia / Q000706:statistics & numerical data; D000700:Analgesics / Q000008:administration & dosage; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology*; D011446:Prospective Studies; D020127:Recovery of Function; D012371:Robotics
chemical_list: D000700:Analgesics
references: Nezhat C. My journey with the AAGL. J Minim Invasive Gynecol 2010;17:271–7.
references: Panici PB, Muzii L, Palaia I, Manci N, Bellati F, Plotti F, et al.. Minilaparotomy versus laparoscopy in the treatment of benign adnexal cysts: a randomized clinical study. Eur J Obstet Gynecol R B 2007;133:218–22.
references: Mais V, Ajossa S, Guerriero S, Mascia M, Solla E, Melis GB. Laparoscopic versus abdominal myomectomy: a prospective randomized trial to evaluate benefits in early outcome. Am J Obstet Gynecol 1996;174:654–8.
references: Nezhat C. When will video-assisted and robotic-assisted endoscopy replace almost all open surgeries? J Minim Invasive Gynecol 2012;19:238–43.
references: Cho JE, Shamshirsaz AH, Nezhat C, Nezhat C, Nezhat F. New technologies for reproductive medicine: laparoscopy, endoscopy, robotic surgery and gynecology. A review of the literature. Minerva Ginecol 2010;62:137–67.
references: Nezhat C, Lavie O, Lemyre M, Unal E, Nezhat C, Nezhat F. Robot-assisted laparoscopic surgery in gynecology: scientific dream or reality? Fertil Steril 2009;91:2620–2.
references: Chen CCG, Falcone T. Robotic gynecologic surgery: past, present and future. Clin Obstet Gynecol 2009;52:335–43.
references: Wu CL, Rowlingson AJ, Partin AW, Kalish MA, Courpas GE, Walsh PC, et al.. Correlation of postoperative pain to quality of recovery in the immediate postoperative period. Region Anesth Pain Med 2005;30:516–22.
references: Paice JA, Cohen F. Validity of a verbally administered numeric rating scale to measure cancer pain intensity. Cancer Nurs 1997;20:88–93.
references: Berdine HJ, Nesbit SA. Equianalgesic dosing of opioids. J Pain Palliat Care Pharmacother 2006:20:79–84.
references: Kho RM, Hilger WS, Hentz JG, Magtibay PM, Magrina JF. Robotic hysterectomy: technique and initial outcomes. Am J Obstet Gynecol 2007;197:113.e1–4.
references: Magrina JF, Kho RM, Weaver AL, Montero RP, Magtibay PM. Robotic radical hysterectomy: comparison with laparoscopy and laparotomy. Gynecol Oncol 2008;109:86–91.
references: Nezhat FR, Datta MS, Liu C, Chuang L, Zakashansky K. Robotic radical hysterectomy versus total laparoscopic radical hysterectomy with pelvic lymphadenectomy for treatment of early cervical cancer. JSLS 2008;12:227–37.
references: Twisk J, Rijmen F. Longitudinal tobit regression: a new approach to analyze outcome variables with floor or ceiling effects. J Clin Epidemiol 2009;62:953–8.
references: Collins SA, Tulikangas PK, O’Sullivan DM. Effect of surgical approach on physical activity and pain control after sacral colpopexy. Am J Obstet Gynecol 2012;206:438.e1–6.
references: Geller EJ, Siddiqui NY, Wu JM, Visco AG. Short-term outcomes of robotic sacrocolpopexy compared with abdominal sacrocolpopexy. Obstet Gynecol 2008;112:1201–6.
references: Paraiso MFR, Jelovsek JE, Frick A, Chen CCG, Barber MD. Laparoscopic compared with robotic sacrocolpopexy for vaginal prolapse. Obstet Gynecol 2011;118:1005–13.
references: Jin LX, Ibrahim AM, Newman NA, Makarov DV, Pronovost PJ, Makary MA. Robotic surgery claims on United States hospital websites. J Healthc Qual 2011;33:48–52.
references: Sarlos D, Kots L, Stevanovic N, Felten S, Schar G. Robotic compared with conventional laparoscopic hysterectomy: a randomized controlled trial. Obstet Gynecol 2012;120:604–11.
references: Nezhat C, Lavie O, Hsu S, Watson J, Barnett O, Lemyre M. Robotic-assisted laparoscopic myomectomy compared with standard laparoscopic myomectomy—a retrospective matched control study. Fertil Steril 2009;91:556–9.
references: Nezhat C, Lewis M, Kotikela S, Veeraswamy A, Saadat L, Hajhosseini B, et al.. Robotic versus standard laparoscopy for the treatment of endometriosis. Fertil Steril 2010;94:2758–60.
references: Nezhat C, Lavie O, Lemyre M, Gemer O, Bhagan L, Nezhat C. Laparoscopic hysterectomy with and without a robot: Stanford experience. JSLS 2009;13:125–8.
references: Pasic RP, Rizzo JA, Fang H, Ross S, Moore M, Gunnarsson C. Comparing robot-assisted with conventional laparoscopic hysterectomy: impact on cost and clinical outcomes. J Minim Invasive Gynecol 2010;17:730–8.
references: Smorgick N, DeLancey J, Patzkowsky K, Advincula A, Song A, As-Sanie S. Risk factors for postoperative urinary retention after laparoscopic and robotic hysterectomy for benign indications. Obstet Gynecol 2012;120:581–6.
references: Hallingbye T, Martin J, Viscomi C. Acute postoperative pain management in the older patient. Aging Health 2011;7:813–28.