title: Decreased expression of hepatic signaling phosphoproteins after laparoscopic and hand-assisted surgery in a porcine model.
abstract: OBJECTIVE
  Minimally-invasive surgery (MIS) is associated with a decreased activation of both systemic and peritoneal immunity compared with the open technique. However, hepatic response to laparoscopic (LAP) and hand-assisted laparoscopic (HAL) surgery has not been defined well. We postulated that both LAP and HAL approaches are associated with a diminished activation of hepatic inflammatory signaling pathways compared with the traditional open surgery.
  
  
  METHODS
  Eighteen pigs underwent a transabdominal nephrectomy via Open, HAL, or LAP approach. Liver samples were obtained 24 h postoperatively and spot frozen. Frozen tissue samples were then homogenized and the nuclear pellets were separated and stored. Nuclear extracts were analyzed for activation of three nuclear signaling phosphoproteins: nuclear factor-kappaB (NFκB)-p65, heat-shock protein 27 (HSP27), and p38 mitogen-activated protein kinases (p38MAPK) using a standard Bioplex technique. Statistical comparison was performed using ANOVA and Student's t-test.
  
  
  RESULTS
  The average expression of HSP27 was significantly higher in the Open versus either the LAP or the HAL groups (P = 0.028 and P = 0.039). The average expression of NFκB-p65 was significantly higher in the Open versus either the LAP or the HAL groups (P = 0.032 and P = 0.049). The average expression of p38MAPK was significantly higher in the Open versus either the LAP or the HAL groups (P = 0.007 and P = 0.036). There was no significant difference in the expressions of HSP27 and NFκB-p65 between LAP and HAL groups (P = 0.38 and P = 0.20), however, detection of p38MAPK generated statistical difference between these two groups (P = 0.018).
  
  
  CONCLUSIONS
  Hand-assisted laparoscopic surgery has been widely accepted as an effective alternative to traditional laparoscopic procedures. We demonstrated that both laparoscopic and hand-assisted approaches resulted in blunted hepatic stress manifested by diminished expression of hepatic HSP27, NFκB, and p38-MAPK. In addition, the hand-assisted approach was equal to the laparoscopic approach in two of the three phosphoproteins studied. It appears that the use of hand-assisted techniques did not abrogate immunologic benefits of pure laparoscopy. Overall, in addition to the clinical benefits of minimal access, both hand-assisted and pure laparoscopic techniques may also confer an immunologic advantage over laparotomy.
authors.affiliation: Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio 44106, USA.
authors.forename: Yue
authors.initials: Y
authors.lastname: Gao
authors.forename: Yi
authors.initials: Y
authors.lastname: Qiao
authors.forename: Donald L
authors.initials: DL
authors.lastname: Kreutzer
authors.forename: Yuri W
authors.initials: YW
authors.lastname: Novitsky
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D055551:HSP27 Heat-Shock Proteins / Q000378:metabolism; D007249:Inflammation / Q000276:immunology* / Q000378:metabolism; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008099:Liver / Q000276:immunology / Q000378:metabolism / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D016328:NF-kappa B / Q000378:metabolism; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods; D010537:Peritoneum / Q000276:immunology / Q000378:metabolism / Q000601:surgery; D010750:Phosphoproteins / Q000378:metabolism*; D011183:Postoperative Complications / Q000276:immunology* / Q000378:metabolism; D015398:Signal Transduction / Q000276:immunology*; D013312:Stress, Physiological / Q000276:immunology; D048051:p38 Mitogen-Activated Protein Kinases / Q000378:metabolism
chemical_list: D055551:HSP27 Heat-Shock Proteins; D016328:NF-kappa B; D010750:Phosphoproteins; D048051:p38 Mitogen-Activated Protein Kinases