Evaluation of tissue trauma after laparoscopic and abdominal hysterectomy: measurements of neutrophil activation and release of interleukin-6, cortisol, and C-reactive protein.
BACKGROUND
Trauma and major surgery stimulate a cascade of events that mediate the inflammatory response. The aim of our study was to determine whether or not hysterectomy leads to release of cytokines, cortisol, and C-reactive protein (CRP), activation of neutrophils, and activation of the complement cascade. A further aim was to compare laparoscopic and abdominal hysterectomy with regard to the same parameters.


METHODS
Twenty-four consecutive patients were randomized to either abdominal (n = 12) or laparoscopic hysterectomy (n = 12). Blood samples were drawn preoperatively, intraoperatively, and then at one minute, 24 hours, and seven days postoperatively. Interleukin-6 (IL-6) levels were used to evaluate cytokine release, cortisol and CRP to evaluate the inflammatory response, and polymorphonuclear (PMN) elastase to detect neutrophil activation. To evaluate complement activation, the terminal C5b-9 complement complex (TCC) was determined.


RESULTS
Interleukin-6 concentrations were significantly elevated one minute and 24 hours postoperatively in both groups. Independent of the surgical technique or operative time, the highest IL-6 concentration was reached four hours after beginning the operation. Cortisol levels were significantly elevated during and after the operation in both groups. C-reactive peptide levels were significantly elevated in both groups 24 hours and seven days after the operation. Polymorphonuclear elastase was elevated 24 hours postoperatively in both groups. There were no signs of complement activation during the operative period or postoperatively in either patient group.


CONCLUSIONS
Our results indicate serious tissue trauma during both laparoscopic and abdominal hysterectomy. The extent of surgical trauma did not differ between the two operative methods.
Ellström
M
M
Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Göteborg, Sweden.
Bengtsson
A
A
Tylman
M
M
Haeger
M
M
Olsson
J H
JH
Hahlin
M
M
D002097:C-Reactive Protein / Q000378:metabolism*; D003167:Complement Activation / Q000276:immunology*; D015938:Complement Membrane Attack Complex / Q000276:immunology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods; D015850:Interleukin-6 / Q000378:metabolism*; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D019272:Leukocyte Elastase; D008875:Middle Aged; D018375:Neutrophil Activation / Q000276:immunology*; D010196:Pancreatic Elastase / Q000378:metabolism; D011446:Prospective Studies; D013997:Time Factors
D015938:Complement Membrane Attack Complex; D015850:Interleukin-6; D002097:C-Reactive Protein; D010196:Pancreatic Elastase; D019272:Leukocyte Elastase; D006854:Hydrocortisone