Laparoscopic vs. open abdominal surgery in male pigs: marked differences in cortisol and catecholamine response depending on the size of surgical incision.
OBJECTIVE
Minimally invasive operations, such as laparoscopic cholecystectomy and adrenalectomy, result in a more rapid recovery of normal function, less physiological disturbances and less stress to the organism than similar open operations. The purpose of this study was to determine the stress response associated with minimally invasive abdominal surgery compared to conventional small or large incision laparotomy.


METHODS
We compared the responses of the stress hormones cortisol and the catecholamines adrenaline and noradrenaline to elective conventional and laparoscopic cholecystectomy and unilateral adrenalectomy in male pigs. Blood samples were taken from all animals at the same time, one day before surgery, at the beginning of the operation, every 15 minutes during surgery and on the first postoperative morning.


RESULTS
Plasma adrenaline and noradrenaline concentrations were significantly lower in both cholecystectomies (p<0.05) and adrenalectomies (p<0.01) during laparoscopic than during open surgery. Plasma cortisol levels were significantly lower in laparoscopic than in open adrenalectomies both during surgery and on postoperative day one (p<0.05), while no major differences in cortisol levels were observed between laparoscopic and open cholecystectomies. Thus, the stress-related benefit of laparoscopic surgery depended on the size of the surgical incision in the conventional operation.


CONCLUSIONS
Laparoscopic surgery was associated with less surgical stress than open surgery and this difference was accentuated as the surgical abdominal wall trauma increased.
Center of Experimental Surgery, Biomedical Research Foundation, Academy of Athens, Athens, Greece.
Angeliki
A
Krikri
Vasileios
V
Alexopoulos
Emmanouil
E
Zoumakis
Paraskevas
P
Katsaronis
Evangelos
E
Balafas
Gregory
G
Kouraklis
Panagiotis E
PE
Karayannacos
George P
GP
Chrousos
Gregory
G
Skalkeas
D034861:Abdominal Wall / Q000601:surgery; D000315:Adrenalectomy / Q000009:adverse effects* / Q000379:methods; D000818:Animals; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002763:Cholecystectomy / Q000009:adverse effects* / Q000379:methods; D003433:Crosses, Genetic; D004837:Epinephrine / Q000097:blood*; D006115:Greece; D006439:Hemodynamics; D006854:Hydrocortisone / Q000097:blood*; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D009638:Norepinephrine / Q000097:blood*; D061646:Operative Time; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control; D013312:Stress, Physiological; D034421:Sus scrofa; D013997:Time Factors
D006854:Hydrocortisone; D009638:Norepinephrine; D004837:Epinephrine