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Biomolecular inflammatory response to surgical energy usage in laparoscopic surgery: results of a randomized study

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Abstract

Objective

Use of surgical energy is integral to laparoscopic surgery (LS). Energized dissection (ED) has a potential to impact the biomolecular expression of inflammation due to ED-induced collateral inflammation. We did this triple-blind randomized controlled (RCT) study to assess this biomolecular footprint in an index LS, i.e., laparoscopic cholecystectomy (LC).

Methods and procedures

This RCT was conducted in collaboration with tertiary-level institutions, from January 2014 to December 2014 with institutional review board clearance. Consecutive, unselected, consenting candidates for LC were randomized (after anesthesia induction) into group I (ED) and group II (non-ED). They were managed with compliance to universal protocols for ethics, informed consent, anesthesia, drug usage and clinical pathway with blinded observers. Biomolecular inflammatory markers, i.e., interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-α) and highly sensitive CRP (HS-CRP), were measured with blood drawn juxta-preoperatively (H0), at 4 h (H4) and at 24 h (H24). The quantitative changes induced by ED on IL-6, TNF-α and HS-CRP at H0, H4 and H24 with their kinetic behavior were the study endpoint. Prospective data were analyzed statistically with a p value of <0.05 being significant.

Results

Two cases from the ED group had biliary injury and hence were withdrawn from analysis. The ED (n = 49) and non-ED (n = 51) groups had similar demographic, clinical and H0 biomolecular variables. There was a significant increase in IL-6, TNF-α and HS-CRP from H0 to H4 in both the groups (p values <0.001). From H4 to H24, all three cytokines showed significant increase in ED group (p < 0.05), whereas in the non-ED group, IL-6 showed significant fall (p = 0.004) and TNF-α showed no significant change (p = 0.063). Both the groups showed H4–H24 elevation of HS-CRP (p = 0.000).

Conclusion

Energized dissection adds to the cytokine-mediated postoperative inflammation. The additional ED-induced inflammation can be measured objectively by IL-6 and TNF-α levels.

Clinical trials registry

Clinical Trials Registry, India (REF/2014/06/007153).

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Acknowledgments

This work was a continuation of our earlier studies. This started with blessings and guidance of Prof. Krishan C Mahajan. He was the founder chairman of our institution and the discipline of surgery in North India after Indian independence. He was very keen to see the conclusion of this study but left us at age 92 in January 2015 after continuously monitoring the present study till his last days. We dedicate this work to his memory. We thank Dr. Manoj Modi, a neonatologist in our institution for helping us with statistics. We are grateful to Ms Pooja and Ms Ramneek for preparation of the manuscript.

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Authors and Affiliations

  1. Department of General and Laparoscopic Surgery, Ganga Ram Institute of Post Graduate Medical Education and Research (GRIPMER), New Delhi, India

    Brij B. Agarwal, Juhil D. Nanavati & Kumar Manish

  2. University College of Medical Sciences, New Delhi, India

    Nayan Agarwal & Naveen Sharma

  3. Safdarjang Hospital, New Delhi, India

    Krishna A. Agarwal

  4. Department of Academics, Ganga Ram Institute of Post Graduate Medical Education and Research (GRIPMER), New Delhi, India

    Satish Saluja

  5. Department of Anatomy, Lady Hardinge Medical College, New Delhi, India

    Sneh Agarwal

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  1. Brij B. Agarwal
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Correspondence to Brij B. Agarwal.

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Brij B. Agarwal, Juhil D. Nanavati, Nayan Agarwal, Naveen Sharma, Krishna A. Agarwal, Kumar Manish, Satish Saluja and Sneh Agarwal have no conflict of interest or financial ties to disclose.

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Agarwal, B.B., Nanavati, J.D., Agarwal, N. et al. Biomolecular inflammatory response to surgical energy usage in laparoscopic surgery: results of a randomized study. Surg Endosc 30, 1733–1741 (2016). https://doi.org/10.1007/s00464-015-4408-2

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