Page 7 - World Journal of Laparoscopic Surgery

WJOLS

Difference between the Inflammatory Reaction Caused by the Placement of a Conventional Laparoscopic Access
recruit neutrophils and monocytes to the inflammatory samples. Although studies using ILs demonstrate that
site. 12,23 A study published by Kato et al (1997) showed a more time could provide more consistent results, the pre­
1
significant increase of IL-8 from baseline to 4 hours after sent study allowed as much time as some other studies.
the procedure in the plasma of patients who underwent The present study aimed to achieve a short­term analysis,
upper­abdominal surgery. 22,24 In contrast, Torres et al excluding the risk of infections or other traumas. In this

(2008) did not observe increased IL­8 at any time up to regard, the transportation of the animals from the farm
48 hours after laparoscopic cholecystectomy with ‘standard to the lab was a variable that could not be controlled due
and low’ pneumoperitoneum pressure. 23 to legal impediments.
IL­10 is also used to measure the inflammatory Like other studies that used rats, dogs or pigs,

response to surgical trauma. A study by Dimopoulou et al the present study was conducted in a porcine animal
(2007) that correlated IL­10 with infectious complications model. 1,16,26 Greco et al compared SA and CL in humans,
showed that IL­6, IL­8 and IL­10 increased proportionally but a nephrectomy was performed in these patients,
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with the surgery time (2, 4, 6 and 8 hours). In a study which might have influence the analysis of ILs because
that measured IL­6, IL­8 and IL­10 to analyze the sur gical that surgery involves different aspects of dissection and
stress response to laparoscopic and open techniques, surgical trauma. 14
no change in the levels of these cytokines after 4, 24 or The present study showed that there was no diffe­
21
48 hours was observed. An analysis of laparoscopic sur­ rence between SA surgery and CL surgery in terms of
gery using standard­or low­pressure pneumoperitoneum inflammatory stress in the absence of induced pneumo-
24
did not show changes in the levels of IL­8 and IL­10. peritoneum. To our knowledge, this is the first study
Tumor neorosis factor­alpha has an important proin­ using access ports exclusively, without pneumoperito­
flammatory action. This cytokine initiates the production neum. SA imposes more technical difficulty on the sur­
of adhesion molecules that lead to the activation and geon and a consequent risk to patients. Therefore, CL
1
proliferation of neutrophils. Matsumoto et al found high surgery remains the most appropriate. However, it is
plasma TNF­a 1 hour after surgery, reaching a peak at still unclear whether the ILs were increased with both
1
4 hours and decreasing after 48 hours. Wang et al did techniques because the two types of access cause a minor
not observe significant changes in the level of TNF-a inflammatory reaction, and it is also not certain whether
when comparing laparoscopic pyeloplasty with open there are other, more accurate ways to assess the degree
21
pyeloplasty in children. In the present study, TNF­a of surgical trauma. Future studies should be performed
was significantly higher at T0 than at T3 when the 20 to validate our findings.
pigs were analyzed together. We think this increase was During the first 4 hours after the opening of access
related to the transportation of the animals. points, there was no significant difference between the
C­reactive protein is often used as a marker of surgi­ inflammatory response triggered by the SA technique
cal trauma because it has a predictable response to acute and the CL technique, without pneumoperitoneum, as
tissue damage. Its action is related to the activation of the assessed by the levels of IL­4, IL­6, IL­8, IL­10, TNF­a
complement cascade and the stimulation of phagocytes and CRP.
by neutrophils and macrophages. C­reactive protein
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increases by 4 hours after surgery and peaks at 24 hours. RefeRenCeS
C­reactive protein is lower in response to laparoscopic
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surgeries compared to open surgeries. 1. Matsumoto ED, Margulis V, Tunc L, et al. Cytokine response
to surgical stress: comparison of pure laparoscopic, hand­
Some authors analyze peritoneal and plasma interleu­ assisted laparoscopic, and open nephrectomy. J Endourol
1
kins to evaluate the traumatic effects of surgery. In the 2005;19(9):1140­1145.
present study, we chose to analyze only blood samples 2. Araujo Filho I, Honorato Sobrinho AA, Rego AC, et al.
because we did not want to perform any manipulation Influence of laparoscopy and laparotomy on gasometry,
leukocytes, and cytokines in a rat abdominal sepsis model.
inside the abdominal cavity. Because we chose not to use Acta Cir Bras 2006;21(2):74­79.
pneumoperitoneum, we only placed the access points and 3. Hanly EJ, Aurora AA, Shih SP, et al. Peritoneal acidosis
did not perform any further trauma. mediates immunoprotection in laparoscopic surgery. Surg
The strengths of the present study include the fact that 2007;142(3):357­364.
it is, to our knowledge, the only one that has compared the 4. Tung PH, Smith CD. Laparoscopic insufflation with room
SA and CL techniques without handling structures inside air causes exaggerated interleukin­6 response. Surg Endosc
the peritoneal cavity. It is also the only study compa­ 1999;13(5):473­475.
5. West MA, Baker J, Bellingham J. Kinetics of decreased LPS­
ring SA and CL without using pneumoperitoneum. The stimulated cytokine release by macrophages exposed to CO .
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main limitation is that we had only 4 hours to collect the J Surg Res 1996;63(1):269­274.
World Journal of Laparoscopic Surgery, January-April 2015;8(1):1-6 5