The net immunologic advantage of laparoscopic surgery

Abstract

The trauma of surgery evokes a variety of physiologic and immunologic alterations that should contribute to host defense. However, an exaggerated response to injury may result in immunosuppression and lead to significant postoperative morbidity and mortality. Laparoscopic surgery may result in less induced surgical trauma than conventional open surgery. Decreased postoperative pain and speedy functional recovery of laparoscopic patients may be attributable to the reduced inflammatory response and minimal immunosuppression. Inflammation, an early protective homeostatic immune response to injury, is characterized by the production of proinflammatory cytokines and by activation of cellular and humoral immune mechanisms. Postoperative levels of the inflammatory cytokines have been consistently lower after laparoscopic procedures, indicating a smaller degree of surgical insult and acute inflammatory reaction. Surgical stress derails the functions of both polymorphonuclear and mononuclear cells, which may lead to an increased risk of postoperative infection. Comparative studies of cellular immunity after laparoscopic and conventional surgery demonstrate immunologic advantage conferred by laparoscopy. Exaggerated activation of peritoneal immunity may lead to a relative local immunosuppression, resulting in ineffective intraperitoneal bacterial clearance and serious postoperative infections. Functions of the peritoneal macrophages are better preserved when laparotomy is avoided. Decreased perioperative stress may be particularly important for oncologic patients. Laparoscopic approaches may result in diminished perioperative tumor dissemination and better cancer outcomes. Although laparoscopy is "minimally invasive," systemic immune responses still are undeniably activated. However, laparoscopic surgery appears to induce a smaller injury, resulting in proportionally decreased immunologic changes. In addition to improved cosmesis and faster functional recovery, a patient undergoing laparoscopic surgery may benefit most from a net immunologic advantage.

Laparoscopic surgery for colorectal cancer is not associated with an increase in the circulating levels of several inflammation-related factors

“…Our series only included laparoscopic patients and, although we did not compare them with patients undergoing open surgery, our findings are in agreement with several previous evidence suggesting a reduced inflammatory response in laparoscopic surgical procedures compared to conventional surgery. 31 Moreover, our findings confirm previous single-marker association studies demonstrating that expression levels of several cytokines are higher in CRC patients compared to control subjects and that they progressively decrease after surgery. These findings suggest that the presence of tumor bulk is per se able to induce a chronic, low-grade inflammatory state and it will be of interest to analyze how and whether it might correlate with disease outcome and with the development of complications (i.e., the development of cachessia and/or hyperalgesic states).…”

Development of subliminal persuasion system to improve the upper limb posture in laparoscopic training: a preliminary study

“…Laparoscopy is a practice widely recognized for abdominal operations [1], and its benefits for the patients, compared to open surgery, are well known: net immunologic advantage [2], reduced post-operative pain, faster recovery and decreased perioperative complications [3], [4], [5]. There is also a consistent number of emergency operations that are now performed by laparoscopy [6].…”

Operação do refluxo gastro-esofágico isolada ou associada à colecistectomia: avaliação do estresse cirúrgico pela dosagem hormonal e de citocinas

“…Com o advento da cirurgia videolaparoscópica, a indicação do tratamento operatório dessas afecções, isoladas ou associadas, tem se difundido amplamente. Diversos estudos têm demonstrado que a abordagem laparoscópica dessas afecções apresentam vantagens, tais como: diminuição da dor pós operatória; menores complicações infecciosas; menor disfunção pulmonar; menor tempo de internação e, quando analisadas do ponto de vista do estresse cirúrgico, menor trauma medido pelos hormônios do estresse (ACTH e cortisol) 3,7,[8][9][10] . Contudo, a resposta humoral não contempla totalmente todas as alterações presentes no pós-trauma, particularmente no sistema imunológico.…”

“…Contudo, a resposta humoral não contempla totalmente todas as alterações presentes no pós-trauma, particularmente no sistema imunológico. Diversas citocinas e metabólitos do ácido araquidônico, têm sido considerados como mediadores adicionais dessa resposta e a liberação dessas citocinas, geralmente, sucede a reação hormonal e é por ela provocada 4,[8][9][10][11] . Tem sido descrito que a IL-10 inibe a resposta hiperálgica inflamatória por inibição da produção de citocinas pró-inflamatórias (TNF-a, IL-1 e IL-2), bloqueando a indução da ciclooxigenase 2 (COX-2).…”

“…Outra ação observada da IL-4 é a supressão do atraso na resposta de hipersensibilidade em animais e no homem, possivelmente, por induzir respostas das células Th2. Além disso, inibe a produção da COX-2 com conseqüente redução da produção de prostaglandinas [4][5][6][8][9][10][11][12][13][14] . …”