Laparoscopic bowel injuries are rare but potentially fatal if recognition is delayed. Unlike the situation after open surgery, patients with unrecognized bowel injury after laparoscopy do not present with the typical "acute surgical abdomen." We investigated monocyte, neutrophil, and lymphocyte apoptosis as indicators of the immune response and whether this response is stimulated or suppressed by laparoscopic bowel injury compared with bowel injury induced during open surgery.
After an animal protocol was approved, laparoscopy was performed in a rabbit model. A total of 44 animals were divided into four groups of 11 rabbits each. Laparoscopic bowel injury was created using 30-W electrocautery at 0 (control), 1, and 5 hours after induction of pneumoperitoneum. Bowel injury was created in the fourth group during open laparotomy. Animals were euthanized at 0, 1 day, 1 week, or 2 weeks after surgery. Apoptosis was assessed by staining the nuclei of blood cells with H-33342 dye.
At 1 week, neutrophil, monocyte, and lymphocyte apoptosis levels were 2.4- to 5-fold lower after laparoscopy (1-hour pneumoperitoneum) compared with open surgery. However, at 2 weeks, the percentage of apoptosis had equalized in the two groups. Interestingly, with longer laparoscopic procedures (5 hours), the percentage of apoptosis at 0 and 1 day more closely approached that seen after open surgery. At 2 weeks, there was a significant difference in apoptosis levels in all cell types between the experimental groups compared with controls (P < 0.001). No animals undergoing a 5-hour open procedure survived to 2 weeks after bowel injury.
Open surgery resulted in a significant increase in programmed cell death compared with controls in the immediate postoperative period following bowel injury. Laparoscopic surgery produced a delayed response and after 2 weeks with bowel perforation approached open surgery levels. The difference in the degree of cellular death may be secondary to a smaller degree of stimulation of the immune response in laparoscopic surgery.
[Show abstract][Hide abstract] ABSTRACT: Laparoscopic surgery is associated with a more favorable clinical outcome than that of conventional open surgery. This might be related to the magnitude of the tissue trauma. The aim of the present study was to examine the differences of the neuroendocrine and inflammatory responses between the two surgical techniques.
Twenty-four patients with no major medical disease were randomly assigned to undergo laparoscopic (n = 13) or abdominal hysterectomy (n = 11). Venous blood samples were collected and we measured the levels of interleukin-6 (IL-6), CRP and cortisol at the time before and after skin incision, at the end of peritoneum closure and at 1 h and 24 h after operation.
The laparoscopic hysterectomy group demonstrated less of an inflammatory response in terms of the serum IL-6 and CRP responses than did the abdominal hysterectomy group, and the laparoscopic hysterectomy group had a shorter hospital stay (P < 0.05). The peak serum IL-6 (P < 0.05) and CRP concentrations were significantly less increased in the laparoscopic group as compared with that of the abdominal hysterectomy group (P < 0.05), while the serum cortisol concentration showed a similar time course and changes and there were no significant difference between the groups. The response of interleukin-6 showed a significant correlation with the response of CRP (r = 0.796; P < 0.05).
The laparoscopic surgical procedure leaves the endocrine metabolic response largely unaltered as compared with that of open abdominal hysterectomy, but it reduces the inflammatory response as measured by the IL-6 and CRP levels.
Korean journal of anesthesiology 10/2010; 59(4):265-9. DOI:10.4097/kjae.2010.59.4.265
[Show abstract][Hide abstract] ABSTRACT: The applications of laparoscopy to urological surgery continue to grow at a steady pace. A complete understanding of the physiological and immunological changes associated with pneumoperitoneum is required. We reviewed the physiology of laparoscopy with regard to the major organ systems and summarize the effects of pneumoperitoneum on immune function.
Articles published in the scientific literature from 1990 to 2004 with relevance to laparoscopic physiology and the immune response to pneumoperitoneum were reviewed using PubMed.
Pneumoperitoneum induces predictable pulmonary and renal responses. The cardiovascular and hemodynamic responses are phasic and dynamic in nature, and only generalizations regarding cardiac function can be made. Renal parenchymal and venous compression during pneumoperitoneum are the etiology of oliguria during laparoscopy. The effects are reversible and cause no adverse effects on renal function. There is a general trend toward systemic immune preservation and peritoneal immune depression during insufflation based laparoscopy. Attenuated peritoneal immunity has been demonstrated most consistently by altered macrophage function.
Physiological changes incurred as a result of pneumoperitoneum have minimal adverse effects in healthy individuals undergoing laparoscopic surgery. Interest has grown in the impaired peritoneal immune response to CO2 pneumoperitoneum. Altered intraperitoneal immunity may represent a new avenue for the development of adjuvant therapies for minimally invasive treatments of urological malignancies and for the prevention of port site metastasis. Further elucidation and investigation into the immunological responses to pneumoperitoneum during urological laparoscopic procedures is called for.
The Journal of Urology 11/2005; 174(4 Pt 1):1183-8. DOI:10.1097/01.ju.0000173102.16381.08 · 4.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Laparoscopic surgery has been shown to induce less immune suppression than open surgery, presumably because there is less tissue trauma, a factor that may impact oncologic-disease control. The objective of this study was to compare the cytokine and stress response associated with pure laparoscopic, hand-assisted laparoscopic (HAL), and open nephrectomy.
Fifteen female farm pigs (45-50 kg) underwent transperitoneal laparoscopic, handassisted (HAL), or open nephrectomy (N = 5 in each group). At 1, 4, 24, and 48 hours post-nephrectomy, blood and peritoneal fluid samples were collected for measurement of tumor necrosis factor (TNF) alpha, interleukin (IL)-1beta, and IL-6 using enzyme-linked immunosorbent assay (ELISA) techniques. Body temperature and serum glucose and cortisol were also measured.
No evidence of perioperative infection was detected in any animal through temperature and glucose monitoring. Operating time and blood loss were comparable among the three groups. Peak serum cortisol concentrations were significantly higher in the HAL group than in the pure laparoscopic group at 24 hours (P = 0.02). Serum TFNalpha concentrations were significantly lower in the pure laparoscopy group (40 +/- 6 pg/mL) than in the HAL and open-nephrectomy groups (81 +/- 6 pg/mL and 83 +/- 17 pg/mL, respectively; P < 0.05), although no differences between groups were found in the serum IL-1beta and IL-6 concentrations. Peritoneal IL-1beta was significantly higher in the HAL than in the open-nephrectomy group (2993 +/- 507 pg/mL and 733 +/- 185 pg/mL, respectively; P = 0.05). Peritoneal IL-6 was significantly lower in the pure laparoscopy group (694 +/- 234 pg/mL) than in the open-surgery group (1668 +/- 312 pg/mL) (P = 0.04).
Pure laparoscopic surgery in pigs elicits a less-robust cytokine response than HAL or open nephrectomy with respect to serum TNFalpha and peritoneal IL-6 concentrations, perhaps reflecting less impairment of the immune system. Clinical confirmation is required, and the implications with regard to oncologic tumor surveillance in humans require further study.
Journal of Endourology 11/2005; 19(9):1140-5. DOI:10.1089/end.2005.19.1140 · 1.71 Impact Factor
Kelvin H. Kramp, Marc J. van Det, Nic J. G. M. Veeger, Jean-Pierre E. N. Pierie
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