Comparison of surgical stress between laparoscopy and open surgery in the field of urology by measurement of humoral mediators.
BACKGROUND
Recently, laparoscopic procedures have become more common in urological surgery, and are suggested to be less stressful compared with open surgery; however, little data on objective evaluation of surgical stress after laparoscopic surgery are available. The objective of this study was to compare surgical stress between laparoscopic and open surgery in the field of urology by measurement of humoral mediators.


METHODS
Blood samples were obtained from 25 patients who underwent laparoscopic surgery (laparoscopic radical prostatectomy, 10; retroperitoneoscopic nephrectomy or nephroureterectomy, seven; laparoscopic adrenalectomy, five; and hand-assisted laparoscopic radical nephrectomy, three) and 10 who underwent open surgery (retropubic radical prostatectomy, four; radical cystectomy, three; and radical nephrectomy, three), 48 h before surgery, during surgery, and 24, 48 and 96 h after surgery. Serum levels of interleukin (IL)-6, IL-10 and granulocytic elastase in these samples were measured, and the results were analyzed with respect to several clinical factors.


RESULTS
In both groups, IL-6 and granulocytic elastase levels increased during surgery and reached maximum levels 24 h after surgery; the increase in granulocytic elastase tended to be prolonged compared with that of IL-6. Changes in IL-10 levels in the open surgery group were similar to those of IL-6 and granulocytic elastase levels, whereas IL-10 levels in the laparoscopic surgery group reached a maximum level during surgery and then decreased to the same level as at 48 h before surgery, on the first postoperative day. The maximum levels of these three mediators in the laparoscopic surgery group were significantly lower than those in the open surgery group. IL-6 was closely associated with the interval of fasting and duration of hospitalization after surgery.


CONCLUSIONS
Although the present study was based on retrospective and non-randomized analysis, the findings suggest that serum levels of IL-6, IL-10 and granulocytic elastase are useful as objective markers of surgical stress, and that laparoscopic surgery is markedly less stressful than open surgery.
Department of Urology, Kobe University School of Medicine, Japan.
Hideaki
H
Miyake
Gaku
G
Kawabata
Akinobu
A
Gotoh
Masato
M
Fujisawa
Hiroshi
H
Okada
Soichi
S
Arakawa
Sadao
S
Kamidono
Isao
I
Hara
D005260:Female; D006801:Humans; D016753:Interleukin-10 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010196:Pancreatic Elastase / Q000097:blood*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013312:Stress, Physiological / Q000097:blood* / Q000209:etiology*; D013997:Time Factors; D015599:Trauma Severity Indices; D014570:Urologic Diseases / Q000097:blood* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects*
D015850:Interleukin-6; D016753:Interleukin-10; D010196:Pancreatic Elastase