Effects of low and standard intra-abdominal pressure on systemic inflammation and immune response in laparoscopic adrenalectomy: A prospective randomised study

Abstract

BACKGROUND:The advantages of laparoscopic adrenalectomy (LA) over open adrenalectomy are undeniable. Nevertheless, carbon dioxide (CO2) pneumoperitoneum may have an unfavourable effect on the local immune response. The aim of this study was to compare changes in the systemic inflammation and immune response in the early post-operative (p.o.) period after LA performed with standard and low-pressure CO2 pneumoperitoneum.MATERIALS AND METHODS:We studied, in a prospective randomised study, 51 patients consecutively with documented adrenal lesion who had undergone a LA: 26 using standard-pressure (12-14 mmHg) and 25 using low-pressure (6-8 mmHg) pneumoperitoneum. White blood cells (WBC), peripheral lymphocyte subpopulation, human leucocyte antigen-DR (HLA-DR), neutrophil elastase, interleukin (IL)-6 and IL-1, and C-reactive protein (CRP) were investigated.RESULTS:Significantly higher concentrations of neutrophil elastase, IL-6 and IL-1 and CRP were detected p.o. in the standard-pressure group of patients in comparison with the low-pressure group (P < 0.05). A statistically significant change in HLA-DR expression was recorded p.o. at 24 h, as a reduction of this antigen expressed on the monocyte surface in patients from the standard group; no changes were noted in low-pressure group patients (P < 0.05).CONCLUSIONS:This study demonstrated that reducing the pressure of the pneumoperitoneum to 6-8 mmHg during LA reduced p.o. inflammatory response and averted p.o. immunosuppression.

Effects of Low Versus Standard Pressure Pneumoperitoneum on Renal Syndecan-1 Shedding and VEGF Receptor-2 Expression in Living-donor Nephrectomy: A Randomized Controlled Study

“…29 Our study results mirrored another laparoscopy study that found significantly higher IL-1, IL-6, and CRP levels in the standard-pressure pneumoperitoneum group than in the low pressure pneumoperitoneum group. 16 Yap et al found that laparoscopic donor nephrectomy resulted in nearly 50% of their subjects showing an increase in tumor necrosis factor-alpha (TNF-) excretion and urine neutrophil gelatinase-associated lipocalin (NGAL) after donor nephrectomy, and also validated the previously published study demonstrating the animal models of AKI after nephrectomy resulted in the increased TNF-, IL-6, and monocyte chemoattractant protein-1 expression. 30 Another animal study showed extrarenal IL-6 production from the liver after unilateral nephrectomy.…”

“…The increased intraabdominal pressure causes mechanical compression of the inferior vena cava, renal vasculature, and parenchyma. 13,14 It stimulates sympathetic activity, which is regulated through CO 2 -mediated baroreceptors, and can lead to renal 15,16,17 Advanced venous congestion and decreased renal blood flow leads to tissue hypoperfusion or ischemia that triggers an inflammatory response. 18 Research on animals showed the pneumoperitoneum pressure of 7,15 In humans, increased intra-abdominal pressure caused hypoperfusion in the abdominal or splanchnic regions with or without hypotension, 13,17 and even a slight increased intraabdominal pressure of 10 mmHg has shown to affect the kidney.…”

Effects of Low Versus Standard Pressure Pneumoperitoneum on Renal Syndecan-1 Shedding and VEGF Receptor-2 Expression in Living-donor Nephrectomy: A Randomized Controlled Study

“…29 Our study results mirrored another laparoscopy study that found significantly higher IL-6 levels in the standard-pressure pneumoperitoneum group than in the low pressure pneumoperitoneum group. 16 Yap et al validated the previously published study demonstrating the animal models of AKI after nephrectomy resulted in the increased IL-6. 30 Another animal study showed extrarenal IL-6 production from the liver after unilateral nephrectomy that suggested the elevated cytokine content may be due to the increasing endogenous production.…”

“…13,14 It stimulates sympathetic activity, which is regulated through CO 2 -mediated baroreceptors, and can lead to renal cortical vasoconstriction. 15,16,17 Venous congestion and decreased renal blood flow leads to tissue hypoperfusion that triggers an inflammatory response. 18 Research on animals showed the pneumoperitoneum pressure of 12-18 mmHg resulted in hypoperfusion that induced the release of inflammatory cytokines, neutrophil migration, and renal cell apoptosis in the outer medulla and cortex.…”

Low-pressure pneumoperitoneum with abdominal wall lift in laparoscopic total mesorectal excision for rectal cancer: Initial experience

“…It was reported that LPP reduced the adverse effects on cardiopulmonary function without affecting laparoscopic feasibility[ 5 , 8 ]. It has also proved feasible and safe in cholecystectomy[ 5 , 9 ], Nissen fundoplication[ 10 ], hysterectomy[ 11 ], adrenalectomy[ 12 ] and donor nephrectomy[ 13 ]. Abdominal wall lift (AWL) is another alternative technique to SPP which avoids the destructive changes associated with CO 2 absorption and increased intraabdominal pressure.…”