Robotic vs. uniportal lobectomy: a prospective analysis of postoperative pain, analgesic requirements, and individual risk factors

Česká verze

Authors: L. Tulinský ^1,2 ; N. Jarošová ³; D. Adamica ^1,2 ; P. Bujok ⁴; M. Mitták ^1,2 ; L. Martínek ^1,2
Authors place of work: Chirurgická klinika, LF OU a FN Ostrava ¹; Katedra chirurgických, studií, LF OU ²; Centrální operační sály, FN Ostrava ³; Katedra informatiky, a počítačů, PřF OU ⁴
Published in the journal: Rozhl. Chir., 2025, roč. 104, č. 12, s. 533-542.
Category: Původní práce
doi: https://doi.org/10.48095/ccrvch2025533

Summary

Introduction: Lung carcinoma represents a malignancy with the highest global mortality rate. Surgical treatment remains the cornerstone of curative therapy, with minimally invasive techniques currently dominating the field. This study aimed to compare postoperative pain in patients undergoing lobectomy for lung cancer via uniportal video-assisted thoracoscopic surgery (UVATS) vs. robotic-assisted thoracic surgery (RATS).

Methods: This prospective study included 140 patients (70 RATS, 70 UVATS) undergoing lobectomy with mediastinal lymphadenectomy. Patients assessed their pain using the Short-Form McGill Pain Questionnaire and visual analogue scale (VAS) on the 3^rd and 14^th postoperative days. We also analyzed the influence of age, gender, and BMI on pain perception and analgesic requirements.

Results: Patients following RATS exhibited significantly higher pain intensity compared to UVATS on both the 3^rd (VAS 5.8 ± 2.0 vs. 3.8 ± 1.6; P < 0.00001) and 14^th postoperative days (VAS 2.7 ± 1.1 vs. 2.2 ± 1.1; P = 0.00133). Combined analgesic therapy was more frequently required in the RATS group. Female patients demonstrated markedly higher pain intensity and analgesic requirements in both surgical approaches. Age and BMI had no significant impact on pain perception.

Conclusion: Robotic-assisted surgery is associated with higher postoperative pain compared to uniportal video-assisted thoracoscopy, with differences being more pronounced in female patients. We recommend implementing targeted analgesic strategies for robotic procedures and considering the use of 8-mm ports instead of standard 12-mm ports to reduce chest wall trauma.

Keywords:

analgesia – Minimally invasive surgery – postoperative pain – Lobectomy – robotic-assisted surgery – lung carcinoma – uniportal video-assisted thoracoscopy

Zdroje

1. Sung H, Ferlay J, Siegel RL et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide. CA Cancer J Clin 2021; 71(3): 209–249. doi: 10.3322/caac.21660.

2. Tulinský L, Kepičová M, Ihnát P et al. Radicality of mediastinal lymphadenectomy in minimally invasive pulmonary resection: a comparative analysis of uniportal and multiportal thoracoscopic approaches. Rozhl Chir 2024; 103(2): 48–56. doi: 10.33699/PIS.2024.103.2.48-56.

3. Kolařík J, Stolz A, Vachtenheim J et al. Video-assisted and robotic-assisted thoracoscopic pulmonary lobectomies, our experience. Rozhl Chir 2021; 100(12): 576–583. doi: 10.33699/PIS.2021.100.12.576–583.

4. Wang L, Liu D, Lu J et al. The feasibility and advantage of uniportal video-assisted thoracoscopic surgery (VATS) in pulmonary lobectomy. BMC Cancer 2017; 17(1): 75. doi: 10.1186/s12885-017-3069-z.

5. Gonzalez-Rivas D, Fieira E, Delgado M et al. Uniportal video-assisted thoracoscopic lobectomy. J Thorac Dis 2013; 5(Suppl 3): S234–S245. doi: 10.3978/j.issn.2072-1439.2013.07.30.

6. Niu Z, Cao Y, Du M et al. Robotic-assisted versus video-assisted lobectomy for resectable non-small-cell lung cancer: the RVlob randomized controlled trial. EClinicalMedicine 2024; 74 : 102707. doi: 10.1016/j.eclinm.2024.102707.

7. Gammie JS, Banks MC, Fuhrman CR et al. The pigtail catheter for pleural drainage: a less invasive alternative to tube thoracostomy. JSLS 1999; 3(1): 57–61. doi: 10.1510/jsls.1999.3.1.57.

8. Wildgaard K, Ravn J, Kehlet H. Chronic post-thoracotomy pain: a critical review of pathogenic mechanisms and strategies for prevention. Eur J Cardiothorac Surg 2009; 36(1): 170–180. doi: 10.1016/j.ejcts.2009.02.005.

9. Bendixen M, Jørgensen OD, Kronborg C et al. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial. Lancet Oncol 2016; 17(6): 836–844. doi: 10.1016/S1470-2045(16)00173-X.

10. Piccioni F, Segat M, Falini S et al. Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols. J Thorac Dis 2018; 10(Suppl 4): S555–S563. doi: 10.21037/jtd.2017.12.86.

11. Ip HY, Abrishami A, Peng PW et al. Predictors of postoperative pain and analgesic consumption. Anesthesiology 2009; 111(3): 657–677. doi: 10.1097/ALN.0b013e3181aae87a.

12. Melzack R. The short-form McGill Pain Questionnaire. Pain 1987; 30(2): 191–197. doi: 10.1016/0304-3959(87)91074-8.

13. Šolcová I, Jakoubek B, Sýrová Z et al. Charakteristika souboru adjektiv použitelných pro self-rating. Cesk Psychol 2000; 44(3): 238–250.

14. Novellis P, Maisonneuve P, Dieci E et al. Quality of life, postoperative pain, and lymph node dissection in a robotic approach compared to VATS and OPEN for early stage lung cancer. J Clin Med 2021; 10(8): 1687. doi: 10.3390/jcm10081687.

15. McElnay P, Molyneux M, Krishnadas R et al. Pain and recovery are comparable after either uniportal or multiport video-assisted thoracoscopic lobectomy: an observation study. Eur J Cardiothorac Surg 2014; 47(5): 912–915. doi: 10.1093/ejcts/ezu324.

16. Tajè R, Gallina FT, Forcella D et al. Multimodal evaluation of locoregional anaesthesia efficacy on postoperative pain after robotic pulmonary lobectomy for NSCLC: a pilot study. J Robot Surg 2023; 17(4): 1705–1713. doi: 10.1007/s11701-023-01578-y.

17. Lautenbacher S, Peters JH, Heesen M et al. Age changes in pain perception: a systematic-review and meta-analysis of age effects on pain and tolerance thresholds. Neurosci Biobehav Rev 2017; 75 : 104–113. doi: 10.1016/j.neubiorev.2017.01.039.

18. Šnircová J, Fajt R, Hrabák J et al. Fast-track and ultra fast-track cardiac anaesthesia –⁠ postoperative pain and other parameters observation. Anest Intenziv Med 2007; 18(5): 276–281.

19. Mills SE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth 2019; 123(2): e273–e283. doi: 10.1016/j.bja.2019.03.023.

doc. MUDr. Lubomír Tulinský, Ph.D.

Chirurgická klinika LF OU a FN Ostrava

17. listopadu 1790

708 52 Ostrava

lubomir.tulinsky@fno.cz