1. Robot-assisted laparoscopic cystectomy with intracorporeal urinary diversion vs. open mini-laparotomy cystectomy: evaluation of surgical inflammatory response and immunosuppressive ability of CO2-pneumoperitoneum in an experimental porcine study
- Author
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Kingo, Pernille Skjold, Rasmussen, Thormod Mønsted, Jakobsen, Lotte Kaasgaard, Palmfeldt, Johan, Nørregaard, Rikke, Borre, Michael, and Jensen, Jørgen Bjerggaard
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ILEAL conduit surgery ,URINARY diversion ,CYSTECTOMY ,ALBUMINS ,CERULOPLASMIN ,INFLAMMATORY mediators - Abstract
Objects: To compare surgical inflammatory response (SIR) after radical cystectomy (RC) in a porcine model using minimal invasive techniques. Additionally we aimed to investigate the potential immunosuppressive ability of preoperative CO
2 -pneumoperitoneum (CO2 P). Materials and Methods: Forty female landrace pigs were randomized to five groups: Three intervention groups all having a cystectomy and an ileal conduit either done by robot-assisted laparoscopic technique with intracorporeal urinary diversion (RALC) or an open mini-laparotomy with or without prior CO2 P (OMC ± CO2 P). Two control sham groups with or without prior CO2 P (S ± CO2 P). Serum samples were obtained preoperatively, immediately postoperative, 24, 48 and 72 hours postoperatively, and the inflammatory mediators CRP, Haptoglobin, Ceruloplasmin, Albumin, Cortisol, IL-4, IL-6, IL-12 and IFN-α were measured. Results: Operative time was significantly longer in RALC compared to open groups (OMC ± CO2 P) (p's < .0001). CRP and Haptoglobin levels were significantly higher for surgical intervention groups (SIG) compared to controls 24, 48 and 72 hours postoperatively (p's < .001). At 48 hours, CRP was higher for RALC vs OMC + CO2 P (p = .029). At 72 hours, Haptoglobin was higher for RALC vs open groups (p's <.024). Ceruloplasmin, cortisol, albumin, IL-4, IL-6, IL-12 and IFN-α, revealed no significant differences between SIG. Conclusions: No major differences were found between RALC and OMC regarding the degree of tissue trauma quantified by inflammatory markers. Thirty minutes of CO2- insufflation preoperative appears to have a transient immunosuppressive effect of the innate postoperative SIR, whereas prolonged CO2 P apparently diminishes this effect. [ABSTRACT FROM AUTHOR]- Published
- 2018
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