Evaluation of tissue trauma after different types of laparoscopic hysterectomy

SUMMARYThe extent of tissue trauma determines the degree of inflammatory response aftersurgical procedures. Due to the lesser degree of tissue trauma and reduced inflammatoryresponse in laparoscopy, there may be less postoperative pain and earlier discharge comparedto open surgical procedures. Increasing interest has been shown to laparoscopic hysterectomysince its first performance in 1989. Laparoscopic hysterectomy can be classified intolaparoscopic assisted vaginal hysterectomy, laparoscopic hysterectomy, and total laparoscopichysterectomy. Previous studies have compared the tissue trauma between laparoscopichysterectomy types and abdominal hysterectomy. However, to date, no study has examinedthe degree of tissue trauma in total laparoscopic hysterectomy (TLH), laparoscopichysterectomy (LH) and abdominal hysterectomy (AH) in a single study. Accordingly, wemeasured preoperative, immediate and 24th hour postoperative serum interleukin-6 (IL-6)and C-reactive protein (CRP) levels in a consecutive of patients who underwent hysterectomy.Groups were divided as TLH ( 15 patients ), LH ( 15 patients ) and AH ( 30 patients ).Postoperative 24th hour IL-6 and CRP levels were increased in all groups. CRP levels weresignificantly higher in AH group compared to either laparoscopy groups at postoperative 24thhour. There were no significant difference at the levels of CRP between the two laparoscopygroups. Postoperative 24th hour IL-6 levels were significantly lower in LH than AH.Although postoperative 24th hour IL-6 levels of LH were lower than TLH, this was notstatistically significant. Likewise, although postoperative 24th hour IL-6 levels of TLH werelower than AH, this was not statistically significant. The longest operation times wereobserved in TLH group. Operative times of LH were significantly lower than TLH.In conclusion, our results show that laparoscopic surgery causes less tissue traumathan the conventional open surgery; however we observed no difference between thelaparoscopic hysterectomy groups concerning the postoperative inflammatory response. Wemay prefer LH instead of TLH in suitable conditions since LH causes same level of tissuetrauma as TLH but has the advantage of significantly shorter operation times.