title: Evaluation of serum cytokine release in response to hand-assisted, laparoscopic, and open surgery in a porcine model.
abstract: BACKGROUND
  Although the immunologic benefits of laparoscopic surgery have been established, effects from hand-assisted (HA) surgery have not been investigated thoroughly. We hypothesized that the HA approach maintains the immunologic advantage of laparoscopic surgery compared with the open (O) approach.
  
  
  METHODS
  Six O, HA, and laparoscopic (L) transabdominal left nephrectomies were performed on pigs. Blood samples were taken preoperatively, perioperatively, and postoperatively, and serum interleukin-6 and C-reactive protein levels were measured.
  
  
  RESULTS
  At 24 hours after surgery, interleukin-6 levels were significantly higher in the O group vs the HA and L groups (82.2 vs 37.5 and 29.9 pg/mL, respectively; P < .05). Similar trends were seen at all time periods for both IL-6 and C-reactive protein. No significant differences in postoperative cytokine levels were detected between the HA and L groups.
  
  
  CONCLUSIONS
  The HA approach mimics the immunologic effects of laparoscopic surgery. These data suggest that the HA technique resulted in a reduced systemic immune activation in the early perioperative period when compared with open surgery. In addition to clinical benefits of minimal access, the HA approach also may afford patients an immunologic advantage over laparotomy.
authors: Department of Surgery, University of Connecticut Health Center, Farmington, 06030, USA.
authors: Sean B
authors: SB
authors: Orenstein
authors: Gordie K
authors: GK
authors: Kaban
authors: Demetrius E
authors: DE
authors: Litwin
authors: Yuri W
authors: YW
authors: Novitsky
mesh_terms: D000818:Animals; D002097:C-Reactive Protein / Q000032:analysis*; D005260:Female; D058733:Hand-Assisted Laparoscopy; D015850:Interleukin-6 / Q000097:blood*; D010535:Laparoscopy; D023421:Models, Animal; D009392:Nephrectomy / Q000379:methods*; D013552:Swine; D013997:Time Factors
chemical_list: D015850:Interleukin-6; D002097:C-Reactive Protein