title: Hemodynamic and inflammatory responses following transumbilical and transthoracic lung wedge resection in a live canine model.
abstract: BACKGROUND
  Single-port transumbilical surgery is a well-established platform for minimally invasive abdominal surgery. The aim of this study was to compare the hemodynamics and inflammatory response of a novel transumbilical technique with that of a conventional transthoracic technique in thoracic exploration and lung resection in a canine model.
  
  
  METHODS
  Sixteen dogs were randomly assigned to undergo transumbilical thoracoscopy (n = 8) or standard thoracoscopy (n = 8). Animals in the umbilical group received lung resection via a 3-cm transumbilical incision in combination with a 2.5-cm transdiaphragmatic incision. Animals in the standard thoracoscopy group underwent lung resection via a 3-cm thoracic incision. Hemodynamic parameters (e.g., mean arterial pressure, heart rate, cardiac index, systemic vascular resistance, and global end-diastolic volume index) and inflammatory parameters (e.g., neutrophil count, neutrophil 2',7' -dichlorohydrofluorescein [DCFH] expression, monocyte count, monocyte inducible nitric oxide synthase expression, total lymphocyte count, CD4+ and CD8+ lymphocyte counts, the CD4+/CD8+ratio, plasma Creactive protein level, interleukin-6 level) were evaluated before surgery, during the operation, and on postoperative days 1, 3, 7, and 14.
  
  
  RESULTS
  Lung resections were successfully performed in all 16 animals. There were 2 surgery-related mortality complications (1 animal in each group). In the transumbilical group, 1 death was caused by early extubation before the animal fully recovered from the anesthesia. In the thoracoscopic group, 1 death was caused by respiratory distress and the complication of sepsis at 5 days after surgery. There was no significant difference between the two techniques with regard to the hemodynamic and immunologic impact of the surgeries.
  
  
  CONCLUSIONS
  This study suggests that the hemodynamic and inflammatory changes with endoscopic lung resection performed by the transumbilical approach are comparable to those after using the conventional transthoracic approach. This information is novel and relevant for surgeons interested in developing new surgical techniques in minimally invasive surgery.
authors.affiliation: Department of Thoracic Surgery, Chang Gung Memorial Hospital, Kaohsiung, Chang Gung University, Taiwan.
authors.forename: Hung-Yi
authors.initials: HY
authors.lastname: Lu
authors.affiliation: Laboratory Animal Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yen
authors.initials: Y
authors.lastname: Chu
authors.affiliation: Laboratory Animal Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yi-Cheng
authors.initials: YC
authors.lastname: Wu
authors.affiliation: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chien-Ying
authors.initials: CY
authors.lastname: Liu
authors.affiliation: Laboratory Animal Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Ming-Ju
authors.initials: MJ
authors.lastname: Hsieh
authors.affiliation: Laboratory Animal Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yin-Kai
authors.initials: YK
authors.lastname: Chao
authors.affiliation: Laboratory Animal Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Ching-Yang
authors.initials: CY
authors.lastname: Wu
authors.affiliation: Laboratory Animal Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Hsu-Chia
authors.initials: HC
authors.lastname: Yuan
authors.affiliation: Laboratory Animal Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Po-Jen
authors.initials: PJ
authors.lastname: Ko
authors.affiliation: Laboratory Animal Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan. Electronic address: zebraairmail@gmail.com.
authors.forename: Yun-Hen
authors.initials: YH
authors.lastname: Liu
authors.affiliation: Laboratory Animal Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Hui-Ping
authors.initials: HP
authors.lastname: Liu
mesh_terms: D000818:Animals; D002097:C-Reactive Protein / Q000032:analysis; D004285:Dogs; D006439:Hemodynamics; D007249:Inflammation / Q000209:etiology*; D015850:Interleukin-6 / Q000097:blood; D007958:Leukocyte Count; D023421:Models, Animal; D011013:Pneumonectomy / Q000379:methods*; D013906:Thoracoscopy / Q000379:methods*; D014472:Umbilicus / Q000601:surgery
chemical_list: D015850:Interleukin-6; D002097:C-Reactive Protein
keywords: Hemodynamics; Inflammation; Lung resection; Transumbilical thoracoscopy