Open Access

MINIMALLY INVASIVE AND ROBOTIC SURGERY

Robot-assisted radical cystectomy versus open radical cystectomy: assessment of postoperative pain

Khurshid A. Guru^1,4, Gregory E. Wilding^3,6, Pamela Piacente¹, Jannah Thompson⁴, Wei Deng⁶, Hyung L. Kim^1,4, James Mohler^1,4, Kathleen O’Leary^2,5

1 Department of Urologic Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA
2 Department of Anesthesia, Roswell Park Cancer Institute, Buffalo, New York, USA
3 Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, New York, USA
4 Department of Urology, State University of New York at Buffalo, Buffalo, New York, USA
5 Department of Anesthesia, State University of New York at Buffalo, Buffalo, New York, USA
6 Department of Biostatistics, State University of New York at Buffalo, Buffalo, New York, USA
Address Correspondence to Dr. Khurshid A. Guru,Department of Urologic Oncology, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263 USA

Canadian Journal of Urology 2007, 14(6), 3753-3756.

Abstract

Introduction: To date, no study has compared postoperative pain and requirement for pain medications in open versus robot-assisted radical cystectomy. Patient reported pain and opiate use were reviewed retrospectively using prospectively collected data from postoperative day one to day of discharge.
Materials and methods: Twenty consecutive robot-assisted radical cystectomy patients were compared to the prior 20 patients who underwent open radical cystectomy. Data was collected prospectively to determine opiate requirements and pain scores in each group. Daily opiate use was converted to morphine sulfate equivalents (MSE) to facilitate comparison. A Likert pain perception scale was used to assess perceived pain. Statistical models were used to test for differences in opiate usage and pain perception between groups of patients who underwent open versus robot-assisted surgery.
Results: Seven patients were excluded from the study (three from the open group, and four from the robotic group): five due to preoperative opiate usage, one due to missing pain data, and one whose procedure was aborted due to unresectable disease. All patients were similar with respect to age, body mass index and pathological parameters. Average MSE usage differed significantly between the two groups on all postoperative days (p < 0.007) whereas average pain scores were similar in the two groups.
Conclusion: Patients who underwent robot-assisted radical cystectomy achieved similar pain control but required less opiates than those who underwent open radical cystectomy.

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