title: Perioperative humoral stress response to laparoscopic versus open aortobifemoral bypass surgery.
abstract: Minimally invasive surgery seems to reduce hormonal stress response to surgery, but has not previously been examined in major abdominal vascular surgery. Aortic cross-clamping time and operation time is known to be longer in the totally laparoscopic aortobifemoral bypass (LABF) as compared to open aortobifemoral bypass (OABF). The main objective of our study was to measure the hormonal stress response during surgery and aortic cross-clamping in patients undergoing a totally laparoscopic versus an open aortobifemoral bypass. This was a sub-study of a larger randomized controlled multicentre trial. Thirty consecutive patients with severe aortoiliac occlusive disease were randomized to either a laparoscopic (LABF) or an open (OABF) procedure. The surgical stress response was measured by perioperative monitoring of adrenocorticotropic hormone (ACTH), aldosterone, metanephrine and cortisol at eight different time-points. During surgery. there was an increase in all humoral stress markers in both groups. The analysis of covariance showed increased levels of cortisol and ACTH in open group at 24 h time-point as compared to the baseline and this difference was statistically significant between the two groups, which indicate an earlier return to baseline levels in the laparoscopic group. Results from the General Estimated Equations (GEE) model indicate that LABF generates a lower level of metanephrine and higher level of aldosterone as compared to OABF. In conclusion, although they have higher levels of ACTH, aldosterone and cortisol during surgery, the patients operated with a laparoscopic aortobifemoral bypass achieve earlier hormonal homeostasis after surgery compared to open aortobifemoral bypass.
authors.affiliation: a Institute of Clinical Medicine, University of Oslo , Oslo , Norway.|b Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases , Oslo University Hospital , Oslo , Norway.
authors.forename: Anne H
authors.initials: AH
authors.lastname: Krog
authors.affiliation: a Institute of Clinical Medicine, University of Oslo , Oslo , Norway.|c Hormone Laboratory, Department of Medical Biochemistry , Oslo University Hospital , Oslo , Norway.
authors.forename: Per M
authors.initials: PM
authors.lastname: Thorsby
authors.affiliation: d Department of Vascular Surgery , Østfold Central Hospital , Kalnes, Norway.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Sahba
authors.affiliation: e Department of Vascular Surgery , Sørlandet Hospital HF , Kristiansand , Norway.
authors.forename: Erik M
authors.initials: EM
authors.lastname: Pettersen
authors.affiliation: f Oslo Center for Biostatistics and Epidemiology (OCBE) , Oslo University Hospital , Oslo , Norway.
authors.forename: Irene
authors.initials: I
authors.lastname: Sandven
authors.affiliation: a Institute of Clinical Medicine, University of Oslo , Oslo , Norway.|b Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases , Oslo University Hospital , Oslo , Norway.
authors.forename: Jørgen J
authors.initials: JJ
authors.lastname: Jørgensen
authors.affiliation: b Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases , Oslo University Hospital , Oslo , Norway.
authors.forename: Jon O
authors.initials: JO
authors.lastname: Sundhagen
authors.affiliation: b Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases , Oslo University Hospital , Oslo , Norway.
authors.forename: Syed S H
authors.initials: SS
authors.lastname: Kazmi
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000368:Aged; D000450:Aldosterone / Q000097:blood; D001011:Aorta; D050197:Atherosclerosis / Q000097:blood* / Q000473:pathology / Q000601:surgery; D015415:Biomarkers / Q000097:blood; D001026:Coronary Artery Bypass / Q000379:methods / Q000523:psychology*; D005260:Female; D005263:Femoral Artery / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007083:Iliac Artery / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D008676:Metanephrine / Q000097:blood; D008875:Middle Aged; D008991:Monitoring, Physiologic; D061646:Operative Time; D019990:Perioperative Care; D013315:Stress, Psychological / Q000097:blood* / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery
chemical_list: D015415:Biomarkers; D000450:Aldosterone; D008676:Metanephrine; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone
keywords: Adrenocorticotropic hormone; aldosterone; hydrocortisone; laparoscopy; metanephrine