title: Immune and stress mediators in response to bilateral adnexectomy: comparison of single-port access and conventional laparoscopy in a porcine model.
abstract: OBJECTIVE
  To evaluate systemic markers of immune and stress responses after bilateral adnexectomy performed using 2 different laparoscopic techniques in pigs.
  
  
  METHODS
  Prospective comparative study (Canadian Task Force classification II-2).
  
  
  METHODS
  University teaching hospital, research hospital, and tertiary care center.
  
  
  METHODS
  Twenty female Yorkshire pigs undergoing laparoscopic surgery.
  
  
  METHODS
  Animals underwent bilateral salpingo-oophorectomy (ovary and fallopian tube extraction), performed via conventional laparoscopy (n = 10) or the single-port access approach (n = 10).
  
  
  RESULTS
  Injury provokes an acute-phase response, primarily produced by cytokines. The inflammatory response has been well described for major surgery and for conventional laparoscopy; however, little information is currently available for single-port laparoscopy, and none in the gynecologic field. This is the first study to compare serum cytokine interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) concentrations at baseline and in the early postoperative period (2, 4, and 20 hours) after bilateral salpingo-oophorectomy performed via conventional laparoscopy (n = 10) or single-port access (n = 10) in a porcine model. The stress response was measured using glucose and cortisol concentrations and the animals' response to surgery via a 6-category observation-based behavior test. Both IL-6 and TNF-α concentrations peaked at 4 hours after surgery, and were significantly lower in the single-port access group (p = .02) than in the conventional laparoscopy group (p = .02). In addition, in the single-port access group, concentrations of stress markers were slightly lower at all intervals recorded and were statistically significant at 2 hours after the operation for glucose concentration (mean [SD], 164.50 [26.73] mg/dL for conventional laparoscopy vs 86.50 [17.93] mg/dL for single-port access; p = .02).
  
  
  CONCLUSIONS
  Evidence of improved inflammatory and stress responses was recorded in the minimally invasive single-port group. More clinical investigations are needed to further study the applicability of single-port access laparoscopy in gynecologic surgery.
authors.affiliation: Institut Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine, University of Barcelona, Barcelona, Spain. Electronic address: megracia@clinic.ub.es.
authors.forename: Meritxell
authors.initials: M
authors.lastname: Gracia
authors.affiliation: Institut Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine, University of Barcelona, Barcelona, Spain.
authors.forename: Cristian
authors.initials: C
authors.lastname: Sisó
authors.affiliation: Institut Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine, University of Barcelona, Barcelona, Spain.
authors.forename: M Àngels
authors.initials: MÀ
authors.lastname: Martínez-Zamora
authors.affiliation: Anesthesiology Department, Hospital Clínic, Faculty of Medicine, University of Barcelona, Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Sarmiento
authors.affiliation: Immunology Department, Hospital Clínic, Centre de Diagnòstic Biomèdic, Faculty of Medicine, University of Barcelona, Barcelona, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Lozano
authors.affiliation: Immunology Department, Hospital Clínic, Centre de Diagnòstic Biomèdic, Faculty of Medicine, University of Barcelona, Barcelona, Spain.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Arias
authors.affiliation: Anesthesiology Department, Hospital Clínic, Faculty of Medicine, University of Barcelona, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Beltrán
authors.affiliation: Institut Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine, University of Barcelona, Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Balasch
authors.affiliation: Institut Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine, University of Barcelona, Barcelona, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Carmona
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000097:blood; D016207:Cytokines; D004195:Disease Models, Animal; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D010535:Laparoscopy / Q000379:methods; D010052:Ovariectomy; D011184:Postoperative Period; D011446:Prospective Studies; D058994:Salpingectomy; D013312:Stress, Physiological / Q000276:immunology*; D013552:Swine; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
chemical_list: D015415:Biomarkers; D016207:Cytokines; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha
keywords: Animal model; Bilateral adnexectomy; Immune and stress response; Laparoscopy; Single-port access