Laparoscopic hysterectomy appears less painful than robotic surgery



WASHINGTON – Patients who underwent a robotically assisted laparoscopic hysterectomy required significantly more postoperative analgesia than did those who had a conventional laparoscopic hysterectomy.

The findings of a retrospective review may help determine which procedure to go with, when postoperative pain is an important recovery factor, Dr. Megan Wasson said at a meeting sponsored by the AAGL.

Dr. Wasson, a fourth-year ob.gyn. resident at the Christiana Care Health System in Wilmington, Del., reviewed the postoperative analgesic requirements of 353 women who underwent minimally invasive hysterectomy for benign conditions at the facility from 2009 to 2012.

Among the group, 116 had a conventional procedure – 78 had a laparoscopic-assisted supracervical hysterectomy and 38 had a total laparoscopic hysterectomy. Robotically assisted hysterectomy was performed for 237 women – three of these were supracervical hysterectomies and 234 were total hysterectomies.

Because patients received different kinds of pain medication, Dr. Wasson and her colleagues converted all of the pain treatment to oxycodone equivalents.

While the oral oxycodone equivalent intake was not significantly different between the groups, the parenteral oxycodone equivalent was higher (14 mg vs. 26 mg). When both oral and parenteral were combined, the total oxycodone equivalent was 28 mg in the laparoscopic group and almost 38 mg in the robotically assisted group – a significant difference.

Women who had conventional laparoscopic surgery were significantly younger than those who had the robotically assisted surgery (42 vs. 46 years). Significantly more black than white women had laparoscopic surgery (51% vs.14%), while significantly more white women had robotically assisted surgery (83% vs. 41%). There were no differences in the rate of prior cesarean section, laparotomy, or laparoscopy.

The uterus was significantly larger in the laparoscopic group (281 g vs. 203 g). Significantly fewer of these women also had a concomitant salpingo-oophorectomy (25% vs. 29%). In the laparoscopic group, intraoperative blood loss was significantly less (131 mL vs. 170 mL), as was hemoglobin decrease (1.68 g/dL vs. 2.26 g/dL). The composite port size was significantly smaller (25.8 mm vs. 41.6 mm). Total procedure time was similar (176 vs. 170 minutes).

Dr. Wasson had no financial declarations.

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