Page 3 - World Journal of Laparoscopic Surgery

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WJOLS

10.5005/jp-journals-10033-1236
Difference between the Inflammatory Reaction Caused by the Placement of a Conventional Laparoscopic Access
OriginaL articLe

Difference between the Inflammatory Reaction Caused by

the Placement of a Conventional Laparoscopic Access
and a Single Access (Single Port) in Pigs

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1 Ricardo Jordão Duarte, Rodolfo Anísio Santana Torres Bandeira, Angelo Vattimo, Sabrina Thalita dos Reis
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5 Kátia Ramos Moreira Leite, Lilian Maria Cristofani, Miguel Srougi
ABSTRACT InTRoDuCTIon
Single access (SA) has been developed to replace conventional Advances in minimally invasive surgery, such as lapa­
laparoscopy (CL) in order to reduce trauma. However, it is a
controversial issue. roscopy, have brought undoubted benefits to patients
because they are less traumatic to the tissues. Recently,
Objectives: To compare the acute inflammatory responses of
CL and SA, considering only the trauma caused by the place- a technique was introduced that accesses the peritoneal
ment of the access port, at first time without pneumoperitoneum cavity using a single access (SA) (‘single port’ or laparos­
or other surgical manipulation. The variations of serum interleu- copic and endoscopic single site, LESS). It is different
kin (IL)-4, -6, -8 and -10, tumor necrosis factor-alpha (TNF-α)
and C-reactive protein (CRP) were evaluated. from conventional laparoscopy (CL), which regularly
uses three or more access points. This new method aims
Materials and methods: Twenty pigs were randomly divided
into two groups: a SA group and a CL group. In the SA group, to further reduce the morbidity of surgical procedures.
the procedure began with a 2.5 cm skin incision, aponeurosis However, the real benefits of SA in terms of tissue damage
®
and peritoneum, and then the single-access device (Gelport ) are controversial. Furthermore, the procedures that use
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was placed without pneumoperitoneum. In the CL group, the
incision was performed on the skin, aponeurosis and perito- SA, such as nephrectomy and pyeloplasty, are technically
neum, and the four trocars were placed only with the traction of more difficult to perform. Therefore, in patients under­
the abdominal wall. Once the access points were placed, blood going CL procedures, the inflammatory effects need to
samples were collected to measure the cytokines and CRP at: be evaluated more carefully and compared with SA to
time zero (T0), immediately after anesthesia (including intuba-
tion); T1, immediately after the access point(s) was placed; T2, evaluate the benefits of this new technique.
120 minutes after the access point(s) was placed; and T3, 240 The degree of tissue damage caused by both open and
minutes after the access point(s) was placed. laparoscopic surgery can be measured by the immune
Results: The concentrations of IL-4 and TNF-α decreased humoral response mediated by cytokines. 1­4 These
between T0 and T3. IL-10 and CRP also decreased, but not include interleukins (ILs), interferons, colony­stimulating
significantly. IL-6 and IL-8 increased, but not significantly.
factors, tumor necrosis factor­alpha (TNF­a) and growth
Conclusion: During the study, there was no significant diffe-
rence between the inflammatory response triggered exclusively factors. The level of C­reactive protein (CRP) is also used
by placing the SA and CL without pneumoperitoneum. as a marker of tissue damage. Interleukins are a large
Keywords: Interleukin, Laparoscopy, Pig, Single port, Trauma. group of cytokines produced by T lymphocytes and some
phagocytes and tissue cells. They have many functions,
How to cite this article: Duarte RJ, Bandeira RAST, Vattimo
A, dos Reis ST, Leite KRM, Cristofani LM, Srougi M. Difference especially the induction of proliferation and differentia­
5,6
between the Inflammatory Reaction Caused by the Placement tion of other cells that express specific IL receptors.
of a Conventional Laparoscopic Access and a Single Access Tumor necrosis factor­alpha activates macrophages and
(Single Port) in Pigs. World J Lap Surg 2015;8(1):1-6.
granulocytes, increases the adhesion of leukocytes to the
Source of support: Nil
endothelium and induces the synthesis of acute­phase
Conflict of interest: None proteins. C­reactive protein is involved in the stress
7,8
response to surgery, stimulating the phagocytosis by
neutrophils and tissue macrophages. 9
1 Chairman and Head, 2,3,6 Researcher, Biologist
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5 Pathologist, Professor
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oBJeCTIVe
1-7 Department of Urology, São Paulo University; Vicky Safra
Surgery, Teaching and Research Center, São Paulo, Brazil The present study aimed to compare the acute inflamma­
Corresponding Author: Ricardo Jordão Duarte, Department tory responses of CL and SA, considering only the trauma
of Urology, Rua Afonso Bras 525, Conj 82, CEP: 04511- caused by the placement of the access point, by measuring
011 São Paulo, Brazil, Phone: 55-11-3842 62 68, e-mail: the serum levels of IL­4, IL­6, IL­8, IL­10, TNF­a and CRP
ricjordao@uol.com.br
in surgeries performed in an animal model (pig).
World Journal of Laparoscopic Surgery, January-April 2015;8(1):1-6 1