Peritoneal transforming growth factor beta-1 expression during laparoscopic surgery: a clinical trial.
BACKGROUND
Transforming growth factor-beta 1 (TGF-beta1) is a growth factor involved in various biologic processes, including peritoneal wound healing and dissemination of malignancies. Laparoscopic surgery is evolving rapidly, and indications are increasing. The peritoneal TGF-beta1 expression during laparoscopic surgery is unknown.


METHODS
For this study, 50 patients scheduled for laparoscopic cholecystectomy were randomized into five groups, then surgically treated with various pressures, light intensities, and dissection devices. Peritoneal biopsies were taken at the beginning and end of surgery. Tissue concentrations of total and active TGF-beta1 were measured using enzyme-linked immunosorbent assay (ELISA) techniques.


RESULTS
There was no significant difference in either total or active TGF-beta1 concentration between peritoneal biopsies taken at the start of surgery and samples taken at the end of the procedure. Patients who underwent surgery with the ultrasonic scalpel had significant lower levels of both active (p < 0.005) and total (p < 0.01) TGF-beta1 at the end of surgery than patients treated with electrocautery. Patients who had surgery with a high light intensity had significantly lower levels of total TGF-beta1 levels (p < 0.005) with an unchanged active part than patients who had surgery with low light intensity.


CONCLUSIONS
The choice of dissection device and the light intensity used in laparoscopic surgery affect peritoneal TGF-beta1 concentrations, indicating that peritoneal biology can be affected by laparoscopic surgery. Because TGF-beta1 is involved in various biologic processes in the peritoneal cavity, this observation may have important clinical consequences.
Brokelman
Walter J A
WJ
Department of Surgery, Alysis Zorggroep, Locatie Rijnstate Wagnerlaan, 55 6815 AD, Arnhem, The Netherlands. w.brokelman@planet.nl
Holmdahl
Lena
L
Bergström
Maria
M
Falk
Peter
P
Klinkenbijl
Jean H G
JH
Klinkonbijl
Jean H G
JH
Reijnen
Michel M P J
MM
Reijnen
Michael M P J
MM
D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation / Q000379:methods; D004564:Electrocoagulation; D005260:Female; D006801:Humans; D008027:Light; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000378:metabolism*; D053773:Transforming Growth Factor beta1 / Q000378:metabolism*; D014464:Ultrasonic Therapy / Q000295:instrumentation
D053773:Transforming Growth Factor beta1