Laparoscopic-assisted vaginal hysterectomy and the hyperglycemic response to surgery: an observational study

Metabolic and inflammatory responses and subsequent recovery in robotic versus abdominal hysterectomy: A randomised controlled study

BACKGROUND & AIMS

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

Robotic laparoscopic surgery reduced inflammatory responses and recovery time, but these changes were not accompanied by decreased insulin resistance.

CLINICAL TRIAL REGISTRATION

www.ClinicalTrials.gov Identifier no NCT02291406.

Clinical comparison of systemic stress responses between laparoscopic or open anterior resection in rectal cancer patients with anal sphincter preservation

AIM: To compare systemic stress responses after laparoscopic and open anterior resection for rectal cancer patients with anal sphincter preservation to ascertain if the laparoscopic approach causes less stress than an open operation.

METHODS: Seventy-six patients seen from December 2004 to April 2007 were randomized into laparoscopic (36 patients) and open anterior resection (35 patients) groups. Body temperature, white blood cell (WBC) count, and plasma levels of cortisol (COR), interleukin-6 (IL-6) and C-reactive protein (CRP) were measured before and after surgery. Visual analogue scale (VAS) scores were also recorded after operation.

RESULTS: Body temperature, WBC counts (×10⁹/L), COR and IL-6, measured on the first postoperative day, showed significant differences between the laparoscopic and open groups (37.3 ± 0.3℃ vs 37.5 ± 0.2℃; 11.02 ± 2.53 vs 12.66 ± 2.93; 745 ± 159 nmol/L vs 998 ± 148 nmol/L; and 33.61 ± 6.15 ng/L vs 50.31 ± 10.83 ng/L; respectively, P < 0.01). However, there were no significant differences between the two groups before surgery and on the third and fifth days postoperatively (P > 0.05). The postoperative plasma levels of the CRP and VAS scores were significantly decreased in the laparoscopic group compared to the open group on the first, third and fifth days postoperatively (7.05 ± 2.08 mg/L vs 124.8 ± 31.2 mg/L, 10.43 ± 1.29 mg/L vs 156.2 ± 36.0 mg/L, and 5.68 ± 2.35 mg/L vs 85.3 ± 30.9 mg/L, P < 0.01; and 5.2 ± 2.0 vs 9.2 ± 2.8, 2.7 ± 1.2 vs 4.6 ±1.9, and 1.6 ± 1.1 vs 2.2 ± 1.3, P < 0.05).

CONCLUSION: These findings suggest that there is less systemic stress response after laparoscopic anterior resection than after open anterior resection for rectal cancer patients with anal sphincter preservation.

Diabetes mellitus and anesthesia

Diabetes mellitus is an extremely common condition with specific associated comorbidity. Its incidence is rising. Diabetic patients have more perioperative complications than nondiabetic patients. These complications may be related to the presence of organ damage secondary to the diabetes, rather than the defects in carbohydrate metabolism themselves, or to perioperative hyperglycemia. Several new drugs are available for the treatment of diabetes, and these are associated with specific and significant side effects, and varying lengths of action with which the anesthetist should be familiar. Few data are available regarding recommendations for fasting in the presence of these newer drugs. In the postoperative period and during cardiac surgery, hyperglycemia has been shown to be detrimental, and should probably be sought and managed aggressively. The incidence of intraoperative hyperglycemia in noncardiac surgery patients is not as well-defined, nor are the effects of aggressive management.