Decreased expression of hepatic signaling phosphoproteins after laparoscopic and hand-assisted surgery in a porcine model

J Surg Res. 2012 Aug;176(2):608-13. doi: 10.1016/j.jss.2011.09.051. Epub 2011 Oct 20.

Abstract

Objective: Minimally-invasive surgery (MIS) is associated with a decreased activation of both systemic and peritoneal immunity compared with the open technique. However, hepatic response to laparoscopic (LAP) and hand-assisted laparoscopic (HAL) surgery has not been defined well. We postulated that both LAP and HAL approaches are associated with a diminished activation of hepatic inflammatory signaling pathways compared with the traditional open surgery.

Materials and methods: Eighteen pigs underwent a transabdominal nephrectomy via Open, HAL, or LAP approach. Liver samples were obtained 24 h postoperatively and spot frozen. Frozen tissue samples were then homogenized and the nuclear pellets were separated and stored. Nuclear extracts were analyzed for activation of three nuclear signaling phosphoproteins: nuclear factor-kappaB (NFκB)-p65, heat-shock protein 27 (HSP27), and p38 mitogen-activated protein kinases (p38MAPK) using a standard Bioplex technique. Statistical comparison was performed using ANOVA and Student's t-test.

Results: The average expression of HSP27 was significantly higher in the Open versus either the LAP or the HAL groups (P = 0.028 and P = 0.039). The average expression of NFκB-p65 was significantly higher in the Open versus either the LAP or the HAL groups (P = 0.032 and P = 0.049). The average expression of p38MAPK was significantly higher in the Open versus either the LAP or the HAL groups (P = 0.007 and P = 0.036). There was no significant difference in the expressions of HSP27 and NFκB-p65 between LAP and HAL groups (P = 0.38 and P = 0.20), however, detection of p38MAPK generated statistical difference between these two groups (P = 0.018).

Conclusion: Hand-assisted laparoscopic surgery has been widely accepted as an effective alternative to traditional laparoscopic procedures. We demonstrated that both laparoscopic and hand-assisted approaches resulted in blunted hepatic stress manifested by diminished expression of hepatic HSP27, NFκB, and p38-MAPK. In addition, the hand-assisted approach was equal to the laparoscopic approach in two of the three phosphoproteins studied. It appears that the use of hand-assisted techniques did not abrogate immunologic benefits of pure laparoscopy. Overall, in addition to the clinical benefits of minimal access, both hand-assisted and pure laparoscopic techniques may also confer an immunologic advantage over laparotomy.

Publication types

  • Comparative Study

MeSH terms

  • Animals
  • Disease Models, Animal
  • HSP27 Heat-Shock Proteins / metabolism
  • Inflammation / immunology*
  • Inflammation / metabolism
  • Laparoscopy / adverse effects
  • Laparoscopy / methods*
  • Liver / immunology
  • Liver / metabolism
  • Liver / surgery*
  • Minimally Invasive Surgical Procedures / adverse effects
  • Minimally Invasive Surgical Procedures / methods
  • NF-kappa B / metabolism
  • Nephrectomy / adverse effects
  • Nephrectomy / methods
  • Peritoneum / immunology
  • Peritoneum / metabolism
  • Peritoneum / surgery
  • Phosphoproteins / metabolism*
  • Postoperative Complications / immunology*
  • Postoperative Complications / metabolism
  • Signal Transduction / immunology*
  • Stress, Physiological / immunology
  • p38 Mitogen-Activated Protein Kinases / metabolism

Substances

  • HSP27 Heat-Shock Proteins
  • NF-kappa B
  • Phosphoproteins
  • p38 Mitogen-Activated Protein Kinases