Robot-assisted laparoscopic cystectomy with intracorporeal urinary diversion vs. open mini-laparotomy cystectomy: evaluation of surgical inflammatory response and immunosuppressive ability of CO₂-pneumoperitoneum in an experimental porcine study

Abstract

Objects: To compare surgical inflammatory response (SIR) after radical cystectomy (RC) in a porcine model using minimal invasive techniques. Additionally we aimed to investigate the potential immunosuppressive ability of preoperative CO₂-pneumoperitoneum (CO₂P).

Materials and Methods: Forty female landrace pigs were randomized to five groups: Three intervention groups all having a cystectomy and an ileal conduit either done by robot-assisted laparoscopic technique with intracorporeal urinary diversion (RALC) or an open mini-laparotomy with or without prior CO₂P (OMC ± CO₂P). Two control sham groups with or without prior CO₂P (S ± CO₂P). Serum samples were obtained preoperatively, immediately postoperative, 24, 48 and 72 hours postoperatively, and the inflammatory mediators CRP, Haptoglobin, Ceruloplasmin, Albumin, Cortisol, IL-4, IL-6, IL-12 and IFN-α were measured.

Results: Operative time was significantly longer in RALC compared to open groups (OMC ± CO₂P) (p’s < .0001). CRP and Haptoglobin levels were significantly higher for surgical intervention groups (SIG) compared to controls 24, 48 and 72 hours postoperatively (p’s < .001). At 48 hours, CRP was higher for RALC vs OMC + CO₂P (p = .029). At 72 hours, Haptoglobin was higher for RALC vs open groups (p’s < .024). Ceruloplasmin, cortisol, albumin, IL-4, IL-6, IL-12 and IFN-α, revealed no significant differences between SIG.

Conclusions: No major differences were found between RALC and OMC regarding the degree of tissue trauma quantified by inflammatory markers. Thirty minutes of CO_2-insufflation preoperative appears to have a transient immunosuppressive effect of the innate postoperative SIR, whereas prolonged CO₂P apparently diminishes this effect.

Keywords:

• Acute phase response
• comparative study
• cystectomy
• disease models animal
• minimal Invasive surgical procedures
• inflammatory markers

Acknowledgement

The authors thank nurse Lene Foss and the participating medical students and PhD-colleague Marie Elkjaer Carlsen for their dedicated assistance during surgery; Torben Larsen, from Dept. of Animal Health, Welfare and Nutrition and Gitte Kall from the Department of Clinical medicine, Aarhus University for skilled technical support; The animal caretakers at Påskehøjgård for providing the animals. The University of Aarhus Research Foundation, Agnes Niebuhr Jensen Foundation, Minimal Invasive Development Center (MIUC), The Danish Bladder Cancer Group, Karen Elise Jensen’s Foundation, M.L. Jørgensen and Gunnar Hansen’s Foundation and A.P. Møller and wife Chastine Mc-Kinney Møller’s Foundation kindly provided financial support to this project.

Disclosure statement

No potential conflict of interest was reported by the author(s).