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Comparative stress hormone changes during helium versus carbon dioxide laparoscopic cholecystectomy
G P Naude1, M K Ryan, N A Pianim
1Department of Surgery, Harbor UCLA Medical Center, Torrance 90509, USA.
Journal of Laparoendoscopic Surgery
|April 1, 1996
Summary
Laparoscopic surgery causes a significant stress response, increasing stress hormones like cortisol and epinephrine. Using helium for insufflation does not prevent this, contrary to expectations, suggesting it
Area of Science:
- Surgical Innovation
- Physiology
- Anesthesiology
Background:
- Laparoscopic surgery is often called minimally invasive.
- Carbon dioxide (CO2) insufflation in laparoscopic surgery can cause respiratory acidosis.
- Helium insufflation avoids CO2-induced acidosis.
Purpose of the Study:
- To investigate if laparoscopic surgery triggers a physiological stress response.
- To determine if avoiding acidosis with helium insufflation reduces stress hormone levels.
Main Methods:
- Sixteen female patients undergoing laparoscopic cholecystectomy were randomized.
- Groups received either helium or CO2 insufflation (n=8 each).
- Serum cortisol, epinephrine, and norepinephrine were measured at multiple time points.
Main Results:
- Laparoscopic cholecystectomy significantly increased stress hormones (cortisol, epinephrine, norepinephrine) compared to preoperative values.
- Helium insufflation did not prevent stress hormone elevation.
- Epinephrine levels were higher with helium than with CO2 insufflation.
Conclusions:
- Laparoscopic cholecystectomy induces a significant physiological stress response.
- Helium insufflation does not mitigate the stress response associated with laparoscopic surgery.
- The stress hormone elevations challenge the notion of laparoscopic surgery being truly minimally invasive.