| Impact of ERAS implementation on the quality of recovery following robotic laparoscopic gynecological surgery: a randomized controlled trial |
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Seung Woo Song1, Hun Ju Lee2, Jung Hwan Ahn3, Nalai Kim4, San-Hui Lee3 |
1Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
2Department of Preventive Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
3Department of Obstetrics and Gynecology, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
4Department of Obstetrics and Gynecology, Wonju Severance Christian Hospital, Yonsei University, Wonju, Republic of Korea |
Corresponding author:
San-Hui Lee, Tel: +82-33-741-1921 ,
Email: sanaram@yonsei.ac.kr
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Received: 4 June 2025 • Revised: 18 February 2026 • Accepted: 18 February 2026
*Seung Woo Song and Hun Ju Lee contributed equally to this study as co-first authors. |
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| Abstract |
Background
In the gynecology field, robotic laparoscopic surgery is increasingly being used to enhance the quality of care. The Enhanced Recovery After Surgery (ERAS) program, which improves patient outcomes, is becoming the standard of care, but its impact on gynecological patients remains unclear. We compared the effect of ERAS implementation and conventional care for robotic gynecological surgery.
Methods
This parallel-group, randomized controlled trial included patients aged 20–70 years undergoing robotic gynecological surgery at a single tertiary medical center in the Republic of Korea. Patients were randomized to conventional care and ERAS groups in a 1:1 ratio. The customized ERAS protocol encompassed minimized fasting, pre-emptive analgesia, transversus abdominis block, and early ambulation. The primary outcome was the Quality of Recovery-15 (QoR-15) score at 24-h and 1-week postoperatively. Secondary outcomes included postoperative pain, ClavienDindo grade ≥ 3 complications, readmission, and length of hospital stay.
Results
Of the 66 enrolled patients, data of 65 were analyzed (conventional care, n = 32; ERAS, n = 33). Compared with conventional care, ERAS resulted in a significantly better quality of recovery at 24-h (QoR-15 scores: 93 [71117] vs. 124 [103135], P < 0.001) and 1-week postoperatively (QoR-15 scores: 135 [131142] vs. 142 [136148], P = 0.002). Additionally, the ERAS group had less severe postoperative pain and a shorter length of hospital stay. Complication and readmission rates were comparable between the groups.
Conclusions
ERAS implementation in robotic gynecological surgery enhanced the quality of recovery and provided better pain control than conventional care, without affecting patient safety. |
| Key Words:
Enhanced recovery after surgery; Gynecological surgical procedures; Minimally invasive surgical procedures; Non-opioid analgesic; Patient-centered care; Postoperative nausea and vomiting; Remimazolam; Robotic surgical procedures |
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