How minimally invasive is laparoscopic cholecystectomy?

To determine the extent of surgical stress induced by open (n = 20) and laparoscopic (n = 20) cholecystectomy, postoperative serum cortisol, growth hormone, and insulin responses were determined for each group. The groups were similar regarding age, sex distribution, and duration of the surgical procedures. The open cholecystectomy group had significant elevations of serum cortisol, growth hormone, and insulin levels 8 h after surgery (p < 0.05). The increased cortisol and growth hormone levels returned to preoperative control values 48 h after surgery. In the laparoscopically operated group, although all hormones increased after surgery, only the increase in growth hormone was statistically significant (p < 0.05). Serum cortisol and growth hormone levels gradually returned to control values 48 h after surgery, but the increased serum insulin levels remained significantly high in both groups 24 and 48 h after surgery (p < 0.05). It is concluded that acute surgical stress induced by open cholecystectomy is more severe than that induced by laparoscopic surgery as reflected by serum hormone determinations. However, the hormonal convalescence rate was similar for both groups. It appears that laparoscopic cholecystectomy is "minimally invasive" concerning the hormonal responses.