Introduction

Since the first laparoscopic procedures involving diagnostic laparoscopy for gynecological pathology, surgeons have observed less postoperative pain, shorter recovery times, and better cosmesis with laparoscopy compared to conventional open surgery.

Open surgery is associated with a period of immunosuppression in the immediate postoperative period (1). Due to its minimally invasive nature, laparoscopic surgery is believed to lessen surgical trauma and so causes less disturbance of immune function. This may contribute to the rapid recovery noted after many laparoscopic operations. As a result, laparoscopic surgery has been investigated for a potential reduction in stress and immune responses.

A large number of animal—mainly rodent—and human studies have investigated the immune response to laparoscopic surgery by the measurement of a number of recognized immunological markers. As preservation of both systemic and intraperi-toneal immunity is important in surgery in general and particularly in oncological procedures, an understanding of the impact of laparoscopy on immune function is highly relevant. A number of prospective and a few randomized controlled trials comparing laparoscopy to open surgery have been reported.

The immunologic benefits of laparoscopic surgery are most obvious in relatively atraumatic procedures such as cholecystectomy and antireflux surgery. For more complex procedures such as resection of colorectal cancer the benefits are less obvious and the evidence controversial.

Although laparoscopy for colorectal cancer may be associated with higher survival and lower recurrence rates (2), it has been related to high incidence of port site metastasis. This is comparable to the incidence of wound metastasis observed after open surgery (2). Long-term results from randomized trials are eagerly awaited.

As laparoscopy becomes established in the field of urology, the study of immuno-logical dysfunction after procedures such as laparoscopic nephrectomy will become more important. At this time, data from randomized trials are sorely lacking. Perhaps, the laparoscopic equivalent of colorectal surgery is laparoscopic radical cystectomy for bladder cancer. Despite being a challenging technique with potential complications, laparoscopic radical cystectomy has a number of advantages compared to open radical cystectomy. Fluid loss from the bowel during surgery is lesser than open radical cystectomy and there is some evidence that in general the patient's immune system is better preserved with laparoscopy. In our experience of laparoscopic radical cys-tectomy with laparoscopic-assisted ileal conduit postoperative morbidity, blood

10 Ways To Fight Off Cancer

10 Ways To Fight Off Cancer

Learning About 10 Ways Fight Off Cancer Can Have Amazing Benefits For Your Life The Best Tips On How To Keep This Killer At Bay Discovering that you or a loved one has cancer can be utterly terrifying. All the same, once you comprehend the causes of cancer and learn how to reverse those causes, you or your loved one may have more than a fighting chance of beating out cancer.

Get My Free Ebook


Post a comment