Robotic Surgery for Abdominal Wall Hernia Repair by Ricardo Z. Abdalla & Thiago Nogueira Costa

Author:Ricardo Z. Abdalla & Thiago Nogueira Costa
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Postoperative Pain

There are several types of pain associated with robotic surgery: incisional port site pain, pain from the peritoneum being distended with carbon dioxide, visceral pain, and shoulder tip pain. The etiology of postlaparoscopic pain can be classified into at least three categories: visceral, incisional, and shoulder tip pain [6].

Pneumoperitoneum

Laparoscopic surgery generally involves the insufflation of carbon dioxide (CO2) into the peritoneal cavity, producing a pneumoperitoneum that causes an increase in the intra-abdominal pressure (IAP). However, CO2 absorption and elevated IAP during pneumoperitoneum can cause specific pathophysiological effects, such as cardiovascular, pulmonary, and splanchnic perfusion changes [5]. Thus far, several studies have been conducted in an effort to reduce CO2 pressure and minimize the adverse effects of pneumoperitoneum, and they have reported postoperative pain relief after low-pressure pneumoperitoneum [7].

One international guideline recommended use of “the lowest intra-abdominal pressure allowing adequate exposure of the operative field, rather than using a routine pressure” [8]. However, the authors of a recent systematic review concluded that “the recommendation to use low-pressure pneumoperitoneum during laparoscopy is weak” [9]. The most important benefit of low-pressure pneumoperitoneum reported in the researched studies was decreased postoperative pain intensity, especially shoulder tip pain.

There is a correlation between the amount of residual intraperitoneal gas and pain scores postoperatively. Therefore, using lower abdominal pressures when insufflating and aspirating residual gas at the end of the procedure reduces postoperative pain [10].

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