Metabolic and inflammatory responses and subsequent recovery in robotic versus abdominal hysterectomy: A randomised controlled study. Issue 1 (February 2018)

• Record Type: Journal Article
• Authors: Wijk, Lena; Nilsson, Kerstin; Ljungqvist, Olle
• Is Part Of: Clinical nutrition. Volume 37:Issue 1(2018)
• Page Start: 99
• Page End: 106
• Publication Date: 2018-02
• Subjects: Robotic-assisted hysterectomy -- Insulin resistance -- Hysterectomy -- Inflammatory response; ERAS Enhanced Recovery After Surgery -- RTLH Robotic Total Laparoscopic Hysterectomy -- AH Abdominal Hysterectomy -- 6MWT Six minutes walk test -- CRP C-reactive protein -- WBC White blood cell count -- BMI Body Mass Index -- VAS Visual analogue scale -- ADL activities of daily living -- WHO World Health Organisation; Critically ill -- Nutrition -- Periodicals; Diet therapy -- Periodicals; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; Enteral Nutrition -- Periodicals; Parenteral Nutrition -- Periodicals; Metabolism -- Periodicals; Diétothérapie -- Périodiques; Alimentation parentérale -- Périodiques; Alimentation entérale -- Périodiques; Nutrition -- Périodiques; Diet therapy; Enteral feeding; Nutrition; Parenteral feeding; Electronic journals; Periodicals; Electronic journals; 615.854
• DOI: 10.1016/j.clnu.2016.12.015
• Languages: English
• ISSNs: 0261-5614

Abstract

Summary: Background & aims: Surgery causes inflammatory and metabolic responses in the body. The aim of the study was to investigate whether robotic-assisted total laparoscopic hysterectomy induces less insulin resistance than abdominal hysterectomy, and to compare inflammatory response and clinical recovery between the two techniques. Methods: A randomised controlled study at the Department of Obstetrics and Gynaecology, Örebro University Hospital, Sweden. Twenty women scheduled for a planned total hysterectomy with or without salpingo-oophorectomy between October 2014 and May 2015, were randomly allocated to robotic-assisted total laparoscopic hysterectomy or abdominal hysterectomy. Insulin resistance after surgery was measured by the hyperinsulinemic normoglycaemic clamp method, inflammatory response measured in blood samples, and clinical recovery outcomes registered. Results: There were no differences in development of insulin resistance between the robotic group and the abdominal group (mean ± SD: 39% ± 22 vs. 40% ± 19; p = 0.948). The robotic group had a significantly shorter hospital stay (median 1 vs. 2 days; p = 0.005). Inflammatory reaction differed; in comparison to the robotic group, the abdominal group showed significantly higher increases in serum interleukin 6 levels, white blood cell count and cortisol from preoperative values to postoperative peak values. Conclusions: Robotic laparoscopic surgery reduced inflammatory responses and recovery time, but these changes were not accompanied by decreased insulin resistance. Clinical trial registration: www.ClinicalTrials.gov Identifier no NCT02291406.