title: Metabolic and inflammatory responses and subsequent recovery in robotic versus abdominal hysterectomy: A randomised controlled study.
abstract: Surgery causes inflammatory and metabolic responses in the body. The aim of the study was to investigate whether robotic-assisted total laparoscopic hysterectomy induces less insulin resistance than abdominal hysterectomy, and to compare inflammatory response and clinical recovery between the two techniques.
  
  
  
  A randomised controlled study at the Department of Obstetrics and Gynaecology, Örebro University Hospital, Sweden. Twenty women scheduled for a planned total hysterectomy with or without salpingo-oophorectomy between October 2014 and May 2015, were randomly allocated to robotic-assisted total laparoscopic hysterectomy or abdominal hysterectomy. Insulin resistance after surgery was measured by the hyperinsulinemic normoglycaemic clamp method, inflammatory response measured in blood samples, and clinical recovery outcomes registered.
  
  
  
  There were no differences in development of insulin resistance between the robotic group and the abdominal group (mean ± SD: 39% ± 22 vs. 40% ± 19; p = 0.948). The robotic group had a significantly shorter hospital stay (median 1 vs. 2 days; p = 0.005). Inflammatory reaction differed; in comparison to the robotic group, the abdominal group showed significantly higher increases in serum interleukin 6 levels, white blood cell count and cortisol from preoperative values to postoperative peak values.
  
  
  
  Robotic laparoscopic surgery reduced inflammatory responses and recovery time, but these changes were not accompanied by decreased insulin resistance.
  
  
  
  www.ClinicalTrials.gov Identifier no NCT02291406.
authors.affiliation: Department of Obstetrics and Gynaecology, Örebro University Hospital, Sweden; School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Sweden. Electronic address: lena.wijk@oru.se.
authors.forename: Lena
authors.initials: L
authors.lastname: Wijk
authors.affiliation: School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Sweden. Electronic address: kerstin.nilsson.ha@oru.se.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Nilsson
authors.affiliation: School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Sweden; Department of Surgery, Örebro University Hospital, Sweden. Electronic address: olle.ljungqvist@oru.se.
authors.forename: Olle
authors.initials: O
authors.lastname: Ljungqvist
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D007249:Inflammation / Q000097:blood*; D007333:Insulin Resistance / Q000502:physiology*; D015850:Interleukin-6 / Q000097:blood; D007902:Length of Stay / Q000706:statistics & numerical data; D007958:Leukocyte Count; D008875:Middle Aged; D011183:Postoperative Complications; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data
chemical_list: D001786:Blood Glucose; C508600:IL6 protein, human; D015850:Interleukin-6; D006854:Hydrocortisone
keywords: Hysterectomy; Inflammatory response; Insulin resistance; Robotic-assisted hysterectomy