Skip to main content
SpringerLink
Log in

Can preconditioning reduce laparoscopy-induced tissue injury?

  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background: Pneumoperitoneum (P) created to facilitate laparoscopy (L) is associated with splanchnic perfusion, ischemia/reperfusion (I/R) injury, and oxidative stress. In this randomized controlled experimental study with blind outcome assessment, we evaluated the effect of preconditioning (PRE) on L-induced I/R injury. Methods: The subjects were 40 Sprague-Dawley male rats. P was created in all except controls, using carbondioxide (CO2) insufflation under a pressure of 15 mmHg. PRE consisted of 10 min of P, followed by 10 min of deflation (D). The rats were randomized to the following groups: Group P was subjected to 60 min of P. Group P/D was subjected to 60 min of P, followed by 45 min of D. Group PRE/P was subjected to PRE, followed by 60 min of P. Group PRE/P/D was subjected to PRE, followed by 60 min of P and 45 min of D. Group C (control) was subjected to a sham operation, without P. Its anesthesia time was equal to that for group PRE/P/D. At the end of the experiments, the rats were killed; blood, liver, and kidney samples were then obtained and coded. Plasma alanine aminotransferase (ALT) and malondialdehyde (MDA), as well as homogenized tissue MDA levels and glutathione (GSH) activities, were measured; tissue samples were assessed for histopathological evidence of injury; all assessments were done by investigators blinded to the study design. The results were decoded and analyzed statistically with the Kruskal-Wallis and Mann Whitney tests. A p < 0.05 was considered significant. Results: Plasma ALT as well as plasma, liver, and kidney MDA levels and liver and kidney injury scores were increased, whereas liver and kidney GSH values were decreased in groups P and P/D, as compared to group C. Rats subjected to PRE before P had plasma ALT, kidney MDA, and kidney and liver GSH levels comparable to controls; their kidney and liver injury scores were higher than controls but significantly lower than nonpreconditioned animals. PRE enabled decreased plasma, kidney, and liver MDA as well as increased kidney GSH if applied before P; its efficacy on oxidative stress was limited to providing decreased kidney MDA and increased kidney GSH if applied before P/D. However, PRE significantly attenuated kidney and liver injury after P as well as P/D. Conclusion: PRE consisting of 10 min of P followed by 10 min of D decreases the oxidative stress induced by sustained P in the plasma, liver, and kidney. PRE significantly limits liver and kidney injury after prolonged P and P/D. After further studies to define its ideal timing, PRE before L incorporating P may have clinical relevance, especially for elderly patients or those with impaired hepatic and/or renal function or perfusion.

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

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. G Akbulut M Serteser C Polat T Köken F Aktepe S Yilmaz Ç Gökçe Ö Gökçe (2002) ArticleTitleChanges in tissue oxidative stress markers in an experimental model of laparoscopic donor nephrectomy. Transplantation 74 1768–1772 Occurrence Handle10.1097/00007890-200212270-00022 Occurrence Handle1:CAS:528:DC%2BD38Xpslaku7w%3D Occurrence Handle12499896

    Article  CAS  PubMed  Google Scholar 

  2. Z Akçetin G Erdemli HJ Bromme (2000) ArticleTitleExperimental study showing a diminished cytosolic antioxidative capacity in kidneys of aged rats. Urol Int 64 70–73 Occurrence Handle1:CAS:528:DC%2BD3cXktlGktb4%3D Occurrence Handle10810267

    CAS  PubMed  Google Scholar 

  3. VE Andrei M Schein M Margolis JC Rucinski L Wise (1998) ArticleTitleLiver enzymes are commonly elevated following laparoscopic cholecystectomy: is elevated intra-abdominal pressure the cause? Dig Surg 15 256–259 Occurrence Handle10.1159/000018624 Occurrence Handle1:STN:280:DyaK1M%2Fmt1WgsA%3D%3D Occurrence Handle9845595

    Article  CAS  PubMed  Google Scholar 

  4. E Beutler (1970) Red cell metabolism. E Beutler (Eds) A manual of biochemical methods. Grune & Stratton New York 66

    Google Scholar 

  5. JV Bonventre (2002) ArticleTitleKidney ischemic preconditioning. Curr Opin Nephrol Hypertens . 43–48 Occurrence Handle10.1097/00041552-200201000-00007

    Article  Google Scholar 

  6. E Eleftheriadis K Kotzampassi D Botsios E Tzartinoglou H Farmakis J Dadoukis (1996) ArticleTitleSplanchnic ischaemia during laparoscopic cholecystectomy. Surg Endosc 10 324–326 Occurrence Handle10.1007/s004649910051 Occurrence Handle1:STN:280:BymB2s7mtlE%3D Occurrence Handle8779068

    Article  CAS  PubMed  Google Scholar 

  7. E Eleftheriadis K Kotzampassi K Papanotas N Heliadis K Sarris (1996) ArticleTitleGut ischaemia, oxidative stress and bacterial translocation in elevated abdominal pressure in rats. World J Surg 20 11–16 Occurrence Handle10.1007/s002689900002 Occurrence Handle1:STN:280:BymC2cfjsVE%3D Occurrence Handle8588401

    Article  CAS  PubMed  Google Scholar 

  8. GK Glantzounis AD Tselepis AP Tambuki TA Trikalinos AD Manataki DA Galaris EC Tsimoyiannis AM Kappas (2001) ArticleTitleLaparoscopic surgery-induced changes in oxidative stress markers in human plasma. . 15 1315–1319 Occurrence Handle1:STN:280:DC%2BD3MnotV2ksw%3D%3D

    CAS  Google Scholar 

  9. T Hauet D Mothes JM Goujon JL Caritez M Carretier L le Moyec M Eugene JP Tillement (1997) ArticleTitleTrimetazidine prevents renal injury in the isolated perfused pig kidney exposed to prolonged cold ischaemia. Transplantation 64 1082–1086 Occurrence Handle1:CAS:528:DyaK2sXntFSjsL4%3D Occurrence Handle9381535

    CAS  PubMed  Google Scholar 

  10. E Haugen KA Nath (1999) ArticleTitleThe involvement of oxidative stress in the progression of renal injury. Blood Purif 17 58–65 Occurrence Handle10.1159/000014377 Occurrence Handle1:CAS:528:DyaK1MXlsF2gt7g%3D Occurrence Handle10449863

    Article  CAS  PubMed  Google Scholar 

  11. CF Islam RT Mathie MD Dinneen EA Kiely AM Peters PA Grace (1997) ArticleTitleIschaemia-reperfusion injury in the rat kidney: the effect of preconditioning. Br J Urol 79 842–847 Occurrence Handle10.1046/j.1464-410X.1997.00209.x Occurrence Handle1:STN:280:ByiA2cnht1M%3D Occurrence Handle9202547

    Article  CAS  PubMed  Google Scholar 

  12. AJ Kirsch TW Hensle DT Chang (1994) ArticleTitleRenal effects of CO2 insufflation: oliguria and acute renal dysfunction in a rat model. Urology 43 453–459 Occurrence Handle10.1016/0090-4295(94)90230-5 Occurrence Handle1:STN:280:ByuB3crhtlM%3D Occurrence Handle8154067

    Article  CAS  PubMed  Google Scholar 

  13. C Li RM Jackson (2002) ArticleTitleReactive species mechanisms of cellular hypoxia-reoxygenation injury. Am J Physiol Cell Physiol 282 C227–241 Occurrence Handle1:CAS:528:DC%2BD38XhtFGisLg%3D Occurrence Handle11788333

    CAS  PubMed  Google Scholar 

  14. CS Lieber (1997) ArticleTitleRole of oxidative stress and antioxidant therapy in alcoholic and nonalcoholic liver diseases. Adv Pharmacol 38 601–628 Occurrence Handle1:CAS:528:DyaK2sXivVarsg%3D%3D Occurrence Handle8895826

    CAS  PubMed  Google Scholar 

  15. A Meister (1994) ArticleTitleGlutathione-ascorbic acid antioxidant system in animals. J Biol Chem 269 9397–9400 Occurrence Handle1:CAS:528:DyaK2cXis1Kns7k%3D Occurrence Handle8144521

    CAS  PubMed  Google Scholar 

  16. CE Murry RB Jenning KA Reimer (1986) ArticleTitlePreconditioning with ischaemia: a delay of lethal cell injury in ischemic myocardium. Circulation 74 1124–1136 Occurrence Handle3769170

    PubMed  Google Scholar 

  17. T Ogawa Y Mimura N Hiki H Kanauchi M Kaminishi (2000) ArticleTitleIschaemic preconditioning ameliorates functional disturbance and impaired renal perfusion in rat ischaemia-reperfused kidneys. Clin Exp Pharmacol Physiol 27 997–1001 Occurrence Handle10.1046/j.1440-1681.2000.03378.x Occurrence Handle1:CAS:528:DC%2BD3cXovVWrur8%3D Occurrence Handle11117237

    Article  CAS  PubMed  Google Scholar 

  18. H Ohkawa N Ohishi K Yagi (1979) ArticleTitleAssay for lipid peroxidase in animal tissues by thiobarbituric acid reaction. Anal Biochem 95 351–358 Occurrence Handle1:CAS:528:DyaE1MXksFaisbk%3D Occurrence Handle36810

    CAS  PubMed  Google Scholar 

  19. C O’Malley AJ Cunningham (2001) ArticleTitlePhysiologic changes during laparoscopy. Anesthesiol Clin North Am 19 1–19 Occurrence Handle1:STN:280:DC%2BD3MzgtF2mtA%3D%3D

    CAS  Google Scholar 

  20. C Peralta N Prats C Xaus E Gelpi J Rosello-Catafau (1999) ArticleTitleProtective effect of liver ischaemic preconditioning on liver and lung injury induced by hepatic ischaemia-reperfusion in the rat. Hepatology 30 1481–1489 Occurrence Handle1:STN:280:DC%2BD3c%2Fkt1ehtg%3D%3D Occurrence Handle10573528

    CAS  PubMed  Google Scholar 

  21. S Richter A Olinger U Hildebrandt MD Menger B Vollmar (2001) ArticleTitleLoss of physiologic hepatic blood flow (“hepatic arterial buffer response”) during CO2-pneumoperitoneum in the rat. Anesth Analg 93 872–877 Occurrence Handle1:STN:280:DC%2BD3Mrisl2lsg%3D%3D Occurrence Handle11574348

    CAS  PubMed  Google Scholar 

  22. K Sato T Kawamura R Wakusawa (2000) ArticleTitleHepatic blood flow and function in elderly patients undergoing laparoscopic cholecystectomy. Anesth Analg 90 1198–1202 Occurrence Handle1:STN:280:DC%2BD3c3ksFWgtQ%3D%3D Occurrence Handle10781479

    CAS  PubMed  Google Scholar 

  23. A Schachtrupp Ch Toens J Hoer B Klosterhalfen AG Lawong V Schumpelick (2002) ArticleTitleA 24-h pneumoperitoneum leads to multiple organ impairment in a porcine model. J Surg Res 106 37–45 Occurrence Handle10.1006/jsre.2002.6421 Occurrence Handle1:STN:280:DC%2BD38zot1GltQ%3D%3D Occurrence Handle12127806

    Article  CAS  PubMed  Google Scholar 

  24. M Schafer H Sagesser J Reichen L Krahenbuhl (2001) ArticleTitleAlterations in hemodynamics and hepatic and splanchnic circulation during laparoscopy in rats. Surg Endosc 15 1197–1201 Occurrence Handle10.1007/s004640080159 Occurrence Handle1:STN:280:DC%2BD3MnotV2gsg%3D%3D Occurrence Handle11443454

    Article  CAS  PubMed  Google Scholar 

  25. F Serracino-Inglott NA Habib RT Mathie (2001) ArticleTitleHepatic ischaemia-reperfusion injury. Am J Surg 181 160–166 Occurrence Handle10.1016/S0002-9610(00)00573-0 Occurrence Handle1:CAS:528:DC%2BD3MXjtFGgtr8%3D Occurrence Handle11425059

    Article  CAS  PubMed  Google Scholar 

  26. KC Sharma G Kabinoff Y Ducheine J Tierney RD Brandstetter (1997) ArticleTitleLaparoscopic surgery and its potential for medical complications. Heart Lung 26 52–64 Occurrence Handle1:STN:280:ByiC28rks1Q%3D Occurrence Handle9013221

    CAS  PubMed  Google Scholar 

  27. H Sies (1997) ArticleTitleOxidative stress: oxidants and antioxidants. Exp Physiol 82 291–295 Occurrence Handle1:CAS:528:DyaK2sXivFemtLc%3D Occurrence Handle9129943

    CAS  PubMed  Google Scholar 

  28. LM Walker JL York SZ Imam SF Ali KL Muldrew PR Mayeux (2001) ArticleTitleOxidative stress and reactive oxygen species generation during renal ischaemia. Toxicol Sci 63 143–148 Occurrence Handle10.1093/toxsci/63.1.143 Occurrence Handle1:CAS:528:DC%2BD3MXmt12rs7k%3D Occurrence Handle11509754

    Article  CAS  PubMed  Google Scholar 

  29. DM Yellon A Dana (2000) ArticleTitleThe preconditioning phenomenon: a tool for the scientist or a clinical reality? Circ Res 87 543–550 Occurrence Handle11009558

    PubMed  Google Scholar 

  30. S Yilmaz E Ateş C Polat T Köken Ç Tokyol G Akbulut Ö Gökçe (2003) ArticleTitleIschaemic preconditioning decreases laparoscopy-induced oxidative stress in small intestine. Hepatogastroenterology 50 .

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey

    S. Yilmaz, G. Akbulut, C. Polat & O. Gokce

  2. Department of Biochemistry, Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey

    T. Koken, A. Kahraman & M. Serteser

  3. Department of Pathology, Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey

    C. Tokyol

  4. Department of Internal Medicine, Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey

    C. Gokce

Authors
  1. S. Yilmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Koken
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Tokyol
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Kahraman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Akbulut
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Serteser
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C. Polat
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. C. Gokce
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. O. Gokce
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Yilmaz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yilmaz, S., Koken, T., Tokyol, C. et al. Can preconditioning reduce laparoscopy-induced tissue injury? . Surg Endosc 17, 819–824 (2003). https://doi.org/10.1007/s00464-002-9096-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-002-9096-z

Keywords

Search

Navigation