CO2 Pneumoperitoneum Modifies the Inflammatory Response to Sepsis

Hanly, Eric J.; Mendoza-Sagaon, Mario; Murata, Kazanuri; Hardacre, Jeffrey M.; Maio, Antonio De; Talamini, Mark A.

doi:10.1097/01.sla.0000055271.58945.e2

Cited by 64 publications

(56 citation statements)

References 30 publications

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“…In the present study the total white cell count and circulating neutrophil were significantly lower following laparoscopic CLP using CO 2 than following LAP/CLP. Laparotomic CLP produced a significant reduction in lymphocyte count compared to laparoscopic CLP using CO2, corroborating with data from other authors 37 . Another work has shown a profound drop in white blood cells in animals subjected to laparotomy or pneumoperitoneum under intraperitoneal inoculation of Escherichia coli, without difference between them.…”

Section: Discussionsupporting

confidence: 82%

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Influence of laparoscopy and laparotomy on gasometry, leukocytes and cytokines in a rat abdominal sepsis model

et al. 2006

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Purpose: Laparoscopic surgery is associated with reduced surgical trauma, and less acute phase response, as compared with open surgery. Cytokines are important regulators of the biological response to surgical and anesthetic stress. The aim of this study was to determine if CO 2 pneumoperitoneum would change cytokine expression, gas parameters and leukocyte count in septic rats. Methods: Wistar rats were randomly assigned to five groups: control (anesthesia only), laparotomy, CO 2 pneumoperitoneum, cecum ligation and puncture by laparotomy, and laparoscopic cecum ligation and puncture. After 30 min of the procedures, arterial blood samples were obtained to determine leukocytes subpopulations by hemocytometer. TNFα, IL-1β, IL-6 were determined in intraperitoneal fluid (by ELISA). Gas parameters were measured on arterial blood, intraperitoneal and subperitoneal exsudates. Results: Peritoneal TNFα, IL-1β and IL-6 concentrations were lower in pneumoperitoneum rats than in all other groups (p<0.05). TNFα, IL-1β and IL-6 expression was lower in the laparoscopic than in laparotomic sepsis (p<0.05). Rats from laparoscopic cecum ligation and puncture group developed significant hypercarbic acidosis in blood and subperitoneal fluid when compared to open procedure group. Total white blood cells and lymphocytes were significantly lower in laparoscopic cecum ligation and puncture rats than in the laparotomic (p<0.01). Nevertheless, the laparotomic cecum ligation rats had a significant increase in blood neutrophils and eosinophils when compared with controls (p<0.05). Conclusions: This study demonstrates that the CO 2 pneumoperitoneum reduced the inflammatory response in an animal model of peritonitis with respect to intraperitoneal cytokines, white blood cell count and clinical correlates of sepsis. The pneumoperitoneum produced hypercarbic acidosis in septic animals. Key words: Pneumoperitoneum. Carbon Dioxide. Sepsis. Acidosis. Leucocytes. RESUMO Objetivo:A cirurgia laparoscópica está associada com trauma reduzido e baixa resposta na fase aguda do trauma, quando comparada com a cirurgia aberta. As citocinas e o balanço ácido-base são fatores importantes da resposta biológica ao trauma cirúrgico-anestésico. O objetivo deste estudo foi determinar se o pneumoperitôneo com CO 2 altera a expressão das citocinas, a gasometria e a contagem diferencial de leucócitos em ratos com sepse abdominal. Métodos: Ratos Wistar foram aleatoriamente distribuídos em 5 grupos: controle (somente anestesia), laparotomia, pneumoperitôneo com CO 2 , ligadura e punção do ceco por laparotomia, ligadura e punção do ceco por laparoscopia. Após 30 minutos dos procedimentos, sangue arterial foi colhido para leucometria diferencial em hemocitômetro. TNFα, IL-1β e IL-6 foram dosadas no líquido intraperitoneal (por ELISA). Os parâmetros gasosos foram medidos no sangue arterial e nos exsudatos intraperitoneal e subperitoneal. Resultados: Os valores de TNFα, IL-1β e IL-6 foram significantemente menores nos ratos submetidos ao pneumoperitôneo do que em...

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Section: Discussionsupporting

confidence: 82%

“…This finding can be explained by the fact that pneumoperitoneum was performed with 3 mmHg pressure, sufficient to keep a normal and spontaneous respiration in rats. This pressure was used in rats by other investigators 37 . By the way, Kuntz et al 35 .…”

Section: Discussionmentioning

confidence: 99%

Influence of laparoscopy and laparotomy on gasometry, leukocytes and cytokines in a rat abdominal sepsis model

et al. 2006

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“…[6,10,14,35,36] In our study, in which these parameters were used, the total leukocyte count was observed to be significantly higher in the peritonitis-induced group than in the control group. However, the leukocyte count was significantly lower in the peritonitis and pneumoperitoneum-induced group in comparison with the sepsis group.…”

Section: Discussionmentioning

confidence: 87%

The effect of carbondioxide pneumoperitoneum on the severity peritonitis

Uzunköy¹,

Özardalı²,

Çelik³

et al. 2012

Ulus Travma Acil Cerrahi Derg

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AMAÇJeneralize peritonit olgularında hala, laparoskopik girişimlerin güvenilirliği ile ilgili kaygılar devam etmektedir. Bu deneysel çalışmada, deneysel peritonit oluşturulan sı-çanlarda karbondioksit (CO 2 ) pnömoperitonyumun enflematuvar cevap ve peritonit şiddeti üzerine etkilerinin araş-tırılması amaçlandı. GEREÇ VE YÖNTEMÇalışmada 21 Wistar albino cinsi sıçan kullanıldı. Sıçanlar üç gruba ayrıldı. Bunlar; kontrol (grup 1), bakteriyel peritonit oluşturulan grup (grup 2) ve peritonit + CO 2 pnömo-perituan oluşturulan grup (grup 3) idi. İkinci ve üçüncü gruptaki sıçanların periton içine Escherishia coli verilerek peritonit oluşturuldu. Üçüncü gruptaki sıçanlarda CO 2 insuflasyonu ile pnömoperitonyum oluşturuldu. Sıçanlar 24 saat sonra öldürüldü, kan ve karın duvarından periton ör-neği alındı. Tüm gruplarda peritonit şiddet skoru, C-reaktif protein düzeyi ve kanda beyaz küre sayısı değerlendirildi. BULGULARPeritonit şiddet skoru, C-reaktif protein düzeyi ve kan beyaz küre sayısı, ikinci ve üçüncü gruplarda, birinci gruba göre anlamlı düzeyde yüksek bulundu (p<0,05). Üçüncü grupta değerler, ikinci gruptan anlamlı düzeyde düşük bulundu (p<0,05). SONUÇÇalışmamızın sonuçları, CO 2 pnömoperitonyumun Escherishia coli ile peritonit ve sepsis oluşturulan sıçanlarda peritonit şiddetini ve sistemik enflematuvar yanıtı azalttığı-nı göstermiştir.

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“…Another distinction between LRP and ORP is the use of CO 2 insufflation during LRP. Hanly et al 19 proposed that CO 2 -mediated attenuation of the acute phase response may be the underlying mechanism of reduced systemic inflammatory response reported in earlier laparoscopic surgeries. [20][21][22] The immune-modulatory effect of CO 2 is apparently mediated by peritoneal acidosis as acidic solutions had the same effect.…”

Section: Discussionmentioning

confidence: 99%

Effect of surgical procedures on prostate tumor gene expression profiles

Li¹,

Zhang²,

Yin³

et al. 2012

Asian J Androl

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Current surgical treatment of prostate cancer is typically accomplished by either open radical prostatectomy (ORP) or robotic-assisted laparoscopic radical prostatectomy (RALRP). Intra-operative procedural differences between the two surgical approaches may alter the molecular composition of resected surgical specimens, which are indispensable for molecular analysis and biomarker evaluation. The objective of this study is to investigate the effect of different surgical procedures on RNA quality and genome-wide expression signature. RNA integrity number (RIN) values were compared between total RNA samples extracted from consecutive LRP (n511) and ORP (n524) prostate specimens. Expression profiling was performed using the Agilent human whole-genome expression microarrays. Expression differences by surgical type were analyzed by Volcano plot analysis and gene ontology analysis. Quantitative reverse transcription (RT)-PCR was used for expression validation in an independent set of LRP (n58) and ORP (n58) samples. The LRP procedure did not compromise RNA integrity. Differential gene expression by surgery types was limited to a small subset of genes, the number of which was smaller than that expected by chance. Unexpectedly, this small subset of differentially expressed genes was enriched for those encoding transcription factors, oxygen transporters and other previously reported surgery-induced stress-response genes, and demonstrated unidirectional reduction in LRP specimens in comparison to ORP specimens. The effect of the LRP procedure on RNA quality and genome-wide transcript levels is negligible, supporting the suitability of LRP surgical specimens for routine molecular analysis. Blunted in vivo stress response in LRP specimens, likely mediated by CO 2 insufflation but not by longer ischemia time, is manifested in the reduced expression of stress-response genes in these specimens. Asian Journal of Andrology (2012) 14, 708-714; doi:10.1038/aja.2012.54; published online 6 August 2012Keywords: CO 2 insufflation; expression microarray; laparoscopic radical prostatectomy; open radical prostatectomy; prostate cancer; stress response INTRODUCTION Currently, for men with localized prostate cancer, surgical resection of the prostatic tumor is most often accomplished by one of two surgical approaches, open radical prostatectomy (ORP) or robot-assisted laparoscopic radical prostatectomy (RALRP), with the latter operation being increasingly practiced in developed countries. In the United States, RALRP accounts for an estimated 80% of RP surgeries. 1 In China, while RALRP is rarely performed, a substantial percentage of RP surgeries are nevertheless performed minimally invasively, via traditional laparoscopic radical prostatectomy (LRP). LRP is quite similar to RALRP and involves similar surgical approaches and steps that are different from conventional ORP. 2 The principal distinctions in sequential surgical steps between LRP and ORP are illustrated in Figure 1. During LRP, the prostate is typically devascularized earlier by ...

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CO2 Pneumoperitoneum Modifies the Inflammatory Response to Sepsis

Abstract: Intra-abdominal CO2 present during laparoscopy attenuates the acute phase inflammatory response associated with perioperative sepsis.

Cited by 64 publications

References 30 publications

Influence of laparoscopy and laparotomy on gasometry, leukocytes and cytokines in a rat abdominal sepsis model

Influence of laparoscopy and laparotomy on gasometry, leukocytes and cytokines in a rat abdominal sepsis model

The effect of carbondioxide pneumoperitoneum on the severity peritonitis

Effect of surgical procedures on prostate tumor gene expression profiles

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