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Stress response to laparoscopic surgery: a review
M Buunen1, M Gholghesaei, R Veldkamp
1Department of Surgery, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
Surgical Endoscopy
|May 12, 2004
Summary
Laparoscopic surgery results in a lower systemic stress response compared to open surgery, preserving immune function. While carbon dioxide pneumoperitoneum affects local immunity, the overall impact on the immune system is less severe with minimally invasive techniques.
Area of Science:
- Immunology
- Surgical Innovation
- Minimally Invasive Surgery
Background:
- Laparoscopic surgery offers reduced trauma versus open surgery, potentially mitigating acute phase response.
- Immune system impairment can increase risks of surgical infections, metastasis, and sepsis.
- Understanding the immunologic consequences of laparoscopic procedures is crucial for patient outcomes.
Purpose of the Study:
- To assess the immunologic consequences of benign laparoscopic surgery.
- To identify and discuss controversial aspects of laparoscopic surgery's impact on immunity.
Main Methods:
- Conducted a literature search on stress response to laparoscopic and open nonmalignant surgery.
- Utilized MEDLINE and Cochrane databases, supplemented by reference list cross-referencing.
- Included manuscripts published between 1993 and 2002.
Main Results:
- Carbon dioxide pneumoperitoneum impacts local peritoneal immune function.
- Production of tumor necrosis factor and macrophage phagocytotic capacity are less reduced.
- Laparoscopic surgery demonstrates preserved systemic immune function compared to open surgery, evidenced by delayed-type hypersensitivity and leukocyte antigen expression.
Conclusions:
- Intraperitoneal carbon dioxide insufflation attenuates peritoneal immunity.
- Laparoscopic surgery is associated with a reduced systemic stress response compared to open surgery.