Page 4 - World Journal of Laparoscopic Surgery

Ricardo Jordão Duarte et al
MATeRIALS AnD MeThoDS Germany), which consisted of two 10 mm trocars and
two, 5 mm trocars, was used in the CL group.
The present study was conducted at the Vicky Safra
Surgery, Teaching and Research Center (Centro de Ensino In the SA group, the procedure began with a 2.5 cm
e Pesquisa em Cirurgia­CEPEC­Vicky Safra) in association incision in the skin, aponeurosis and peritoneum,
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with the medical research laboratory of the Division of followed by placement of a SA device (Gelport ) without
Urology (LIM55), with the approval of the Medical Ethics pneumoperitoneum (Fig. 1). No other surgical manipu­
Committee of the School of Medicine of the University of lation was performed; we only collected blood samples
São Paulo (Faculdade de Medicina da Universidade de São from the ear of the pigs. In the CL group, the antiseptic
Paulo­FMUSP). The study was conducted according to the preparation was the same. Skin, peritoneum and aponeu­
Ethical precepts of the animal research facility of FMUSP. rosis incision was performed, and the trocars were placed
Twenty Landrace pigs (domestic pig) from a specia­ without insufflating the abdominal cavity, only with trac­
lized farm were used in the present study. The animals tion on the abdominal wall. In total, four access points
were fasted, sanitized and injected intramuscularly with (trocars) were placed: a 10 mm umbilical access, a 5 mm
3 ml xylazine and 4 ml ketamine, associated with intra­ access in the xiphoid appendix, a 10 mm access in the iliac
muscular injection of 3 ml (15 mg) midazolam as a pre­ fossa and a 5 mm access in the hypochondrium (Fig. 2).
anesthetic medication. The anesthesia, which consisted of Once the access points were placed, blood was collec­
5 to 10 ml of thiopental, was administered by puncturing ted to measure the cytokines and CRP. Four samples were
the ear vein before intubation. After this procedure, the taken from each group: time zero (T0), immediately after
animals were intubated with a 6 mm endotracheal tube, anesthesia (including intubation); T1, immediately after
and 10 ml of thiopental, 4 ml of fentanyl and 2 ml of pan­ the access was placed; T2, 120 minutes after the access
curonium were administered. The ventilation rate was was placed; and T3, 240 minutes after the access points
set to 12 breaths per minute with 100% oxygen (FiO ) and were placed.
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1.5% isoflurane. Every 40 minutes, 10 ml thiopental, 4 ml Analysis of Blood Samples by eLISA
fentanyl and 2 ml pancuronium were administered. An
ear vein was punctured in the contralateral ear to collect The blood samples were collected from the ear vein
blood samples. contralateral to the ear used for the anesthesia. The sam­
ples were centrifuged, and the serum was immediately
Surgical Procedure, Collection of Blood Samples used to perform enzyme­linked immunosorbent assays
from Pigs and Analysis of the Samples (ELISAs). Swine IL­10, IL­4, IL­8 and TNF­a ELISA kits

Two groups of pigs, with 10 animals each, were randomly (Invitrogen Corporation, CA, USA) and a swine CRP kit
assigned to SA or CL. The anesthetized pigs had their (Pig CRP ELISA kit, Genway, CA, USA) were used.
abdomen washed with 2% chlorhexidine disinfectant STATISTICAL AnALySIS
followed by antisepsis with 0.5% chlorhexidine alcohol,
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and sterile drapes were placed. The Gelport (Applied Student’s t­test and the analysis of variance (ANOVA)
Medical, California, EUA) device was used in the SA were used to compare the data between groups. The
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group, and a device from Storz (Karl Storz, Tuttlingen, differences were considered significant when p ≤ 0.05.

Fig. 1: Single port approach employed in the study Fig. 2: Four trocars laparoscopic conventional approach
199 × 100 mm (81 × 122 DPI) employed in the study 167 × 110 mm (123 × 123 DPI)
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