title: Evaluation of acute and chronic pain outcomes after robotic, video-assisted thoracoscopic surgery, or open anatomic pulmonary resection.
abstract: Although robotic-assisted thoracic surgery (RATS) provides improved dexterity, the effect of RATS on pain compared with video-assisted thoracoscopic surgery (VATS) or open lobectomy is poorly understood. This study evaluated acute and chronic pain following RATS, VATS, and open anatomic pulmonary resection.
  
  
  
  A retrospective review of 498 patients (502 procedures) who underwent RATS (74), VATS (227), and open (201) anatomic pulmonary resection including lobectomy and segmentectomy from 2010 to 2014 was performed to identify factors related to acute and chronic pain. Acute pain scores were analyzed over the first 9 postoperative days. Chronic pain was assessed using the validated PainDETECT survey.
  
  
  
  There were no significant differences in acute or chronic pain between RATS and VATS. There was a significant decrease in acute pain for patients with minimally invasive surgery (P = .0004). Chronic numbness was significantly higher after open resection (25.5% vs 11.6%; P = .0269) but with no difference in other symptoms of chronic pain. Despite no significant difference in pain scores, 69.2% of patients who received RATS felt the approach affected pain versus 44.2% VATS (P = .0330). On multivariable analysis, younger age (P < .0001), female gender (P = .0364), and baseline narcotic use (P = .0142) were associated with acute pain, whereas younger age (P = .0021) and major complications (P = .0003) were associated with chronic numbness in patients who received MIS.
  
  
  
  Although minimally invasive approaches resulted in less acute pain and chronic numbness, there were no significant differences between RATS and VATS. In contrast, more RATS patients believed the approach affected their pain, suggesting a difference between reality and perception.
authors.affiliation: Section of Thoracic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich.
authors.forename: Sebastian T
authors.initials: ST
authors.lastname: Kwon
authors.affiliation: Department of Biostatistics, University of Michigan Medical School, Ann Arbor, Mich.
authors.forename: Lili
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Section of Thoracic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich.
authors.forename: Rishindra M
authors.initials: RM
authors.lastname: Reddy
authors.affiliation: Section of Thoracic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Chang
authors.affiliation: Section of Thoracic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Orringer
authors.affiliation: Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Mich.
authors.forename: Chad M
authors.initials: CM
authors.lastname: Brummett
authors.affiliation: Section of Thoracic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich. Electronic address: juleslin@umich.edu.
authors.forename: Jules
authors.initials: J
authors.lastname: Lin
mesh_terms: D059787:Acute Pain / Q000453:epidemiology* / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D008168:Lung / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology* / Q000209:etiology; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D013997:Time Factors; D055815:Young Adult
keywords: acute pain; chronic pain; lobectomy; robotic surgery; thoracoscopy; thoracotomy