Shorter PFA-100-closure times in laparoscopic versus conventional hysterectomy are not caused by increased vasopressin levels.
OBJECTIVE
Bleeding problems during laparoscopic surgery are infrequent. We hypothesised that increased abdominal pressure during the application of the pneumoperitoneum would lead to an increased release of endogenous vasopressin which could then contribute to the hemostasis by increasing platelet reactivity, FVIII and von Willebrand-factor.


METHODS
We compared the vasopressin levels, the platelet function as measured by the PFA-100-test, aPTT and FVIII in 39 consecutive patients who underwent elective hysterectomy (20 with the laparoscopic and 19 with the conventional, "open" method). Blood was sampled the day before surgery and 2, 4 and 72 h after the induction of anaesthesia.


RESULTS
After two hours, the PFA-100 closure times with collagen/ADP decreased to lower levels in the laparoscopic group (from 93 +/- 22 to 82 +/- 20, mean +/- SD) and even further down to 65 +/- 13 s (compared to 82 +/- 20 s) (p = 0.024)) four hours after the beginning of surgery. Vasopressin levels and F VIII increased in both groups but there was no significant difference between the groups (21 vs. 17.8 pmol/l for vasopressin, differences of the mean). Bleeding was minimal, with a trend to lower Hb-levels in the laparotomy group.


CONCLUSIONS
The procedural difference of laparoscopic vs. open hysterectomy appears to enhance platelet reactivity by other mechanisms than increased vasopressin levels and may contribute to an enhanced hemostatic competence in laparoscopic surgery.
Pederiva
S
S
Department of Medicine, Kantonsspital Baden, Switzerland.
Schmid
H R
HR
Brunner
H R
HR
Hohl
M
M
Beer
J H
JH
D000328:Adult; D001792:Blood Platelets / Q000502:physiology; D016001:Confidence Intervals; D005169:Factor VIII / Q000032:analysis; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D010314:Partial Thromboplastin Time / Q000379:methods; D010976:Platelet Count; D010979:Platelet Function Tests / Q000379:methods*; D013997:Time Factors; D014667:Vasopressins / Q000097:blood
D014667:Vasopressins; C078147:F8 protein, human; D005169:Factor VIII