Minimal-invasive surgery (MIS) has been shown in the randomized GOG-LAP2 study to improve peri-operative outcome of patients with endometrial cancer, and should have become the gold standard. However, gyn-oncologists remain reluctant to offer this surgical approach to many of their patients due to the difficulty and steep learning curve of laparoscopy for complex oncological surgery, related to the limitations of the laparoscopic instruments and the fulcrum effect. Robotic surgery’s ergonomic interface has facilitated the adoption of MIS amongst surgeons, allowing more patients to benefit from the technique. To evaluate the added value of robotics, we compared the use of post-operative medications following robotic versus open surgery for the treatment of endometrial cancer.
Retrospective cohort study comparing pain medication usage of 180 patients following robotic surgery to 60 patients following laparotomy matched by stage and age in a 3:1 ratio. Electronic charts were reviewed and all pain medications administered post-operatively were recorded. Medication type, doses, routes of administration, and time of administration were specified. All opioids were converted to equianalgesic doses of Morphine IV based on established guidelines. The Wilcoxon Rank Sum test was used to test for significant differences.
There was a significant decrease in the average dose of both opioid as well as non-opioid medications following robotic surgery compared to laparotomy. Figure 1 shows the differences in postoperative administration of acetaminophen (4825 mg vs 2444 mg), ibuprofen (1996 mg vs 431 mg), and naproxen (1431 mg vs 380 mg) (all P <0.0001), and neurontin (80 mg vs 3.3 mg; P= 0.4). Figure 2 shows the differences in opioid use (73. 8 mg morphine IV equivalent vs 13.4 mg morphine IV equivalent, P <0.0001). There was also a significant decrease in the estimated blood loss (EBL) (P<0.0001) and the length of stay (LOS) (P<0.0001) following robotic surgery.
In comparison to laparotomy, robotic surgery was associated with a significant decrease in the postoperative use of both opioid and non-opioid medications, EBL and LOS.