The anesthesiologist's perspective in choosing between robotic-assisted and conventional laparoscopic urological surgery: a propensity score-matched analysis.

BACKGROUND: Comparative studies between robotic-assisted laparoscopic surgery (RALS) and conventional laparoscopic surgery (CLS) primarily focus on surgical outcomes, with limited emphasis on the anesthesiologist's perspective. This study aimed to compare anesthesia-related Enhanced Recovery After Surgery (ERAS) outcomes to inform surgical decision-making. METHODS: This retrospective study included 831 patients who underwent partial nephrectomy or radical prostatectomy for renal or prostate cancer between September 2021 and October 2023. Propensity score matching (PSM) was performed in a 1:1 ratio based on age, gender, BMI, surgery type, and comorbidities. Primary outcomes included anesthesia time, surgical time, recovery time, and resting/activity VAS scores on postoperative day one (POD1). Secondary outcomes comprised ambulation status, nausea/vomiting, dizziness, and anxiety incidence. Safety indicators were pharyngeal pain, respiratory depression, and oxygen requirement. RESULTS: After PSM, 252 patients were allocated to each group. The RALS group demonstrated significantly longer anesthesia and surgical times compared to the CLS group (P < 0.05). PACU recovery time showed no significant difference. While Rest-VAS on POD1 was similar, Act-VAS was significantly higher in the RALS group (P<0.05). The proportion of patients achieving autonomous mobilization (Grade 1) was significantly lower in the RALS group(P<0.01). Incidences of nausea/vomiting and dizziness were significantly higher in the RALS group (P<0.05). Anxiety incidence was significantly lower in the RALS group (P<0.05). No significant differences were found in sore throat, respiratory depression, or oxygen requirement rates. CONCLUSIONS: These findings suggest that from an anesthesiological perspective, RALS is associated with longer surgical and anesthesia time. The observed differences in postoperative recovery indicators highlight the importance of considering patient physiological reserve when selecting a surgical approach. However, given the observational nature of this study, these findings should be considered hypothesis-generating and warrant prospective validation.