Abstracts
1997 Digestive Disease Week
Laparoscopic colon surgery is less stressful than
conventional colon surgery.
PE Marchesa, JW Milsom, A Vignali, A Vladisavjevic, S Dei, L Rybicki, VW
Fazio. Departments of Colorectal Surgery and Biostatistics, The Cleveland Clinic
Foundation, Cleveland OH.
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Background: Circadian rhythm (CR) disruption may be one of the most
sensitive indicators of degree of stress after events such as surgery. Aim: To
compare the disturbances of preoperative motor activity, body temperature, and
heart rate CR following laparoscopic vs conventional right hemicolectomy in a
canine model. Material and methods: Male beagle dogs (n=24; age 7-8 months) were
kept under highly controlled photo-periodic conditions (12 h light and 12 h
dark) in a sound-attenuated room. All dogs carried a data acquisition system
able to simultaneously record loco-motor activity, EKG, and body temperature 23
hours/day. CR periodicity of these parameters was studied using TAUTM
analysis software (Minimitter Co SunRiver OR). Data were downloaded daily to a
personal computer, collected for a mean of 7.5 days preop and 9 days postop.
Dogs underwent laparoscopic (Lap, n=12) or conventional (Conv, n=12)-
right hemicolectomy. Enright's periodogram was used to determine existence of
circadian cycles. ANOVA and paired t-tests were also used. Results: 19 dogs
(laparoscopic n=9, conventional n=10) were studied. 5 dogs were excluded due to
hypothermic (n=2), surgical (volvulus n=2), or recording (n=1) complications. In
the preop period there were no statistical differences between groups for
loco-motor activity, EKG, and body temperature (p=0.56, 0.65, 0.45;
respectively). The following reports the duration (hours) and changes in CR
periodicity over the study period.
Variable Group Pre-op Post-op Variance p-value
Temperature Conv 24.4(1.1) 23.4(0.7) -1.0(1.4) 0.06
( ) = SD Lap 23.6(1.0) 23.5(0.7) -0.1(0.9) 0.78
Heart Rate Conv 24.4(0.7) 23.6(0.7) -0.7(0.7) 0.006*
Lap 23.6(0.5) 23.3(0.3) -0.3(0.6) 0.21
Locomotor Conv 24.4(0.8) 25.3(0.6) 1.0(1.1) 0.021*
Lap 24.0(0.6) 24.3(0.6) 0.3(0.6) 0.2
There were no differences in the pre vs. postop CRs in the laparoscopic
group in any parameter. In the conventional group, heart rate and locomotor
activity circadian periodicities were significantly altered postoperatively and
temperature almost reached statistical significance (p=0.06). Conclusions: Under
highly controlled circumstances biological circadian periodicity was preserved
after laparoscopic but not after conventional colon surgery in a dog model. Our
findings support the hypothesis that laparoscopic colon surgery is overall less
stressful. (This research was funded in part by U.S. Surgical Corporation,
Norwalk, CT).
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