Skip to main content
SpringerLink
Log in

Leukocytosis after robotic hysterectomy: commonly observed but clinically insignificant

  • Original Article
  • Published:
Journal of Robotic Surgery Aims and scope Submit manuscript

Abstract

Laboratory studies are commonly performed after surgery, but with little evidence of clinical utility. We evaluated our experience with measuring a complete blood count (CBC) to determine peripheral blood leukocyte count (WBC) postoperatively following consecutive robotic hysterectomies. From January 2008 through November 2009, two surgeons (KM, HM) performed 204 robotic hysterectomies. Patient age, weight, height, indication for surgery, surgical procedure, operative time, estimated blood loss, hospital length of stay, postoperative fever, and complications were prospectively recorded and correlated with WBC measured on the day after surgery. The postoperative WBC was elevated (>11,000/μl) in 59/204 (29%) patients. Eight (4%) patients had marked leukocytosis (WBC >15,000/μl; maximum 16,600/μl). There was no correlation between postoperative leukocytosis and operative time, BMI, performance of lymphadenectomy, or length of hospitalization. The only factor significantly associated with elevated postoperative WBC was elevated preoperative WBC (P < .001). Also, there was no correlation between postoperative leukocytosis with fever or infectious complications. The mean T max was 37.1ºC and T max over 38ºC was seen in nine patients. Of the five women who developed infectious complications, only one (diagnosed with pneumonia) had a minimally elevated postoperative WBC (11,600/μl); the other four (pneumonia and pelvic abscess, two each) had normal postoperative WBC. Routine measurement of WBC after robotic hysterectomy is not useful. In about 25% of cases there will be a slight leukocytosis, and rarely (about 4%) will the WBC exceed 15,000/μl. In no case was measurement of postoperative WBC clinically relevant.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kirov SM, Shepherd JJ, Donald KD (1979) Intraoperative and postoperative changes in peripheral white blood cell counts: the contribution of stress. Aust N Z J Surg 49:738–742

    Article  CAS  PubMed  Google Scholar 

  2. Tonnesen E, Hohndorf K, Lerbjerg G, Christensen NJ, Huttel MS, Andersen K (1993) Immunological and hormonal responses to lung surgery during one-lung ventilation. Eur J Anaesthesiol 10:189–195

    CAS  PubMed  Google Scholar 

  3. Brohee D, Vanhaeverbeek M, Kennes B, Neve P (1990) Leukocyte and lymphocyte subsets after a short pharmacological stress by intravenous epinephrine and hydrocortisone in healthy humans. Int J Neurosci 53:53–62

    Article  CAS  PubMed  Google Scholar 

  4. Bell DM, Goldmann DA, Hopkins CC, Karchmer AW, Moellering RC Jr (1978) Unreliability of fever and leukocytosis in the diagnosis of infection after cardiac valve surgery. J Thorac Cardiovasc Surg 75:87–90

    CAS  PubMed  Google Scholar 

  5. Miholic J, Hiertz H, Hudec M, Laczkovics A, Domanig E (1984) Fever, leucocytosis and infection after open heart surgery. A log-linear regression analysis of 115 cases. Thorac Cardiovasc Surg 32:45–48

    Article  CAS  PubMed  Google Scholar 

  6. Verkkala K, Valtonen V, Jarvinen A, Tolppanen EM (1987) Fever, leucocytosis and C-reactive protein after open-heart surgery and their value in the diagnosis of postoperative infections. Thorac Cardiovasc Surg 35:78–82

    Article  CAS  PubMed  Google Scholar 

  7. Boggess JF, Gehrig PA, Cantrell L, Shafer A, Ridgway M, Skinner EN, Fowler WC (2008) A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy. Am J Obstet Gynecol 199:360e361–360e369

    Google Scholar 

  8. De Nardis SA, Holloway RW, GEt Bigsby, Pikaart DP, Ahmad S, Finkler NJ (2008) Robotically assisted laparoscopic hysterectomy versus total abdominal hysterectomy and lymphadenectomy for endometrial cancer. Gynecol Oncol 111:412–417

    Article  Google Scholar 

  9. Rebeles SA, Muntz HG, Wieneke-Broghammer C, Vason ES, McGonigle KF (2009) Robot-assisted total laparoscopic hysterectomy in obese and morbidly obese women. J Robot Surg 3:141–147

    Article  Google Scholar 

  10. Veljovich DS, Paley PJ, Drescher CW, Everett EN, Shah C, Peters WA (2008) Robotic surgery in gynecologic oncology: program initiation and outcomes after the first year with comparison with laparotomy for endometrial cancer staging. Am J Obstet Gynecol 198:679 e671–679 discussion 679 e679–610

    Article  Google Scholar 

  11. Leung KL, Lai PB, Ho RL, Meng WC, Yiu RY, Lee JF, Lau WY (2000) Systemic cytokine response after laparoscopic-assisted resection of rectosigmoid carcinoma: a prospective randomized trial. Ann Surg 231:506–511

    Article  CAS  PubMed  Google Scholar 

  12. Bauer AR Jr, McNeil C, Trentelman E, Swift SA, Mason JD (1978) The depression of T lymphocytes after trauma. Am J Surg 136:674–680

    Article  PubMed  Google Scholar 

  13. Decker D, Schondorf M, Bidlingmaier F, Hirner A, von Ruecker AA (1996) Surgical stress induces a shift in the type-1/type-2 T-helper cell balance, suggesting down-regulation of cell-mediated and up-regulation of antibody-mediated immunity commensurate to the trauma. Surgery 119:316–325

    Article  CAS  PubMed  Google Scholar 

  14. Hong JY (2005) The effect of preoperative ketorolac on WBC response and pain in laparoscopic surgery for endometriosis. Yonsei Med J 46:812–817

    Article  CAS  PubMed  Google Scholar 

  15. Hosokawa T, Hori Y, Ohtsuka T, Nakagawa H, Miyazaki M (1989) Effect of anesthesia and surgery on immunity in patients with benign and malignant diseases. Masui 38:343–349

    CAS  PubMed  Google Scholar 

  16. Neilan BA, Taddeini L, Strate RG (1977) T lymphocyte rosette formation after major burns. JAMA 238:493–496

    Article  CAS  PubMed  Google Scholar 

  17. Ryhanen P, Saarela E, Saukkonen J, Hollmen A (1977) Circulatory responses to laryngoscopy and endotracheal intubation in patients with and without cardiovascular disease. Effect of prophylactic practolol. Ann Chir Gynaecol 66:294–298

    CAS  PubMed  Google Scholar 

  18. Shimaoka M, Hosotsubo K, Sugimoto M, Sakaue G, Taenaka N, Yoshiya I, Kiyono H (1998) The influence of surgical stress on T cells: enhancement of early phase lymphocyte activation. Anesth Analg 87:1431–1435

    Article  CAS  PubMed  Google Scholar 

  19. Slade MS, Simmons RL, Yunis E, Greenberg LJ (1975) Immunodepression after major surgery in normal patients. Surgery 78:363–372

    CAS  PubMed  Google Scholar 

  20. Bolton PM, Kirov SM, Donald KJ (1979) The effects of major and minor trauma on lymphocyte kinetics in mice. Aust J Exp Biol Med Sci 57:479–492

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Women’s Cancer Care of Seattle, Northwest Hospital and Medical Center, 1560 North 115th Street, Suite 101, Seattle, WA, 98133, USA

    Meenu Goel, Kathryn F. McGonigle, Emily Vason & Howard G. Muntz

Authors
  1. Meenu Goel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kathryn F. McGonigle
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emily Vason
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Howard G. Muntz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Howard G. Muntz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Goel, M., McGonigle, K.F., Vason, E. et al. Leukocytosis after robotic hysterectomy: commonly observed but clinically insignificant. J Robotic Surg 4, 235–239 (2010). https://doi.org/10.1007/s11701-010-0214-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11701-010-0214-y

Keywords

Search

Navigation