Acute postoperative pain management after living donor hepatectomy during the transition from an open to minimally invasive surgical approach.

Abstract

Background: Acute post-surgical pain is a common concern for patients undergoing living donor hepatectomy (LDH), potentially leading to unfavorable outcomes if not treated adequately. This study aimed to evaluate the impact of the transition of surgical techniques from open and laparoscopic to robot-assisted minimally invasive surgical (MIS) approach, and the different types of graft resection, including right, left, and left lateral partial lobectomy (LL), on analgesia requirements during the first two postoperative days.

Methods: A single-center retrospective electronic chart review of all patients who underwent LDH procedures between 2018 and 2020 was performed.

Results: Patients underwent LDH procedure (n = 414) through open (n = 93, 22%), laparoscopic (n = 68, 16%), or robot-assisted MIS (n = 253, 61%) approaches; and had right lobectomy (n = 215, 52%), left lobectomy (n = 121, 29%), or LL (n = 78, 19%). Postoperatively within the first 48 h, the pain reported on a 3-point Visual Analogue Scale (VAS), was mild 77%, moderate 21%, or severe only 2%. The laparoscopic approach and LL resection were associated with higher pain scores, whereas the robotic approach was the least painful overall.

Conclusions: Robot-assisted MIS approach for LDH procedure resulted in lower acute pain scores when compared with other surgical approaches, obviating the need for intravenous (IV) patient-controlled analgesia (PCA).