Perioperative Recovery and Narcotic Use in Laparoscopic Versus Robotic Surgery for Endometrial Cancer.

STUDY OBJECTIVE To compare intra-operative and peri-operative narcotic use, recovery room time, and total hospital stay for patients treated with robotic versus laparoscopic surgery for endometrial cancer. DESIGN Retrospective cohort SETTING: Teaching hospital PATIENTS: All patients having minimally invasive surgery in the division of gynecologic oncology during a 20-month period. INTERVENTION Laparoscopic cases were compared to robotic assisted cases with respect to peri-operative outcome MEASUREMENT & MAIN RESULTS: Hospital billing records were used to identify all patients with endometrial cancer treated from 1/1/2018 through 7/31/2019 undergoing either laparoscopic or robotic surgery. Data were collected including total narcotic use converted to milligrams (mg) of IV morphine equivalent (MEq), total amount of time in recovery, and length of hospital stay. A total of 139 laparoscopic and 101 robotic surgeries were eligible for analysis. There was no difference between the groups with respect to blood loss, alcohol use, or smoking. Laparoscopic patients had a significantly lower BMI compared to robotic patients (32.9 vs. 38.0 kg/m2; p < .001). Univariate analysis showed no difference between the two groups with respect to narcotic use in surgery (21.7 vs 21.1 mg MEq; p = .64), recovery (4.3 vs 4.5 mg mg MEq; p= .70), or total dose (26.0 vs 25.6 mg MEq; p= .78). However, robotic patients had a longer recovery room time (128 min vs 163 min; p < .001 and a longer surgical time (288 min vs 204 min; p = .001). Robotic patients were also more likely to undergo full lymphadenectomy than laparoscopic patients (38.0% vs. 20.8% P < .001). In multivariate analysis the only significant factors for predicting total narcotic dose were age, use of a preoperative ERAS program, and surgical time. Laparoscopic patients were more likely to achieve same-day discharge (39.3% vs 17.8%; p= .0003), but in multivariate analysis type of surgery did not predict same day discharge. CONCLUSIONS There is no difference in narcotic use in the peri-operative period with robotic surgery compared to laparoscopy. Recovery time was longer for robotic surgery but this was not significant in multivariate analysis. Same day discharges are less frequent with robotics, which may be more related to physician choice rather than procedure.