Laparoscopic-assisted vaginal hysterectomy and the hyperglycemic response to surgery: an observational study.
OBJECTIVE
To test the hypothesis that laparoscopic-assisted vaginal hysterectomy (LAVH) attenuates the hyperglycemic response to surgery when compared to vaginal hysterectomy (VH).


METHODS
Fourteen patients received either LAVH (n=7) or VH (n=7). Whole body glucose production was measured before and three hours after surgery using [6.6-2H2] glucose. Before, during and after the operation, plasma concentrations of glucose, insulin, glucagon, cortisol, epinephrine and norepinephrine were determined.


RESULTS
Plasma glucose concentration increased in both groups during and after surgery showing a significantly higher value after VH than after LAVH (VH: 8.3 +/- 1.4 mmol x L(-1); LAVH: 6.6 +/- 0.9 mmol x L(-1), P <0.05). The postoperative increase in glucose production was comparable in both groups. While plasma concentrations of insulin and glucagon remained unchanged, intra- and postoperative plasma cortisol concentrations were significantly higher in the VH group than in the LAVH group. Plasma catecholamine concentrations significantly increased after both types of surgery to the same extent.


CONCLUSIONS
In this observational study, LAVH appears to blunt the hyperglycemic and cortisol response to surgery when compared to VH.
Lattermann
R
R
Department of Anesthesia, McGill University, Montreal, Quebec, Canada.
Schricker
T
T
Wachter
U
U
Georgieff
M
M
Schreiber
M
M
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D006439:Hemodynamics; D006801:Humans; D007045:Hysterectomy, Vaginal; D007432:Intraoperative Period; D010535:Laparoscopy; D008875:Middle Aged; D011184:Postoperative Period
D001786:Blood Glucose