Minimal modulation of lymphocyte and natural killer cell subsets followingminimal access surgery

BACKGROUND: Trauma, whether accidental or surgically induced, is known to c ause significant modulation of the cell-mediated immune response. Minimal a ccess surgery (MAS) has been shown to improve postoperative recovery and en hance rehabilitation. The degree of immunosuppression resulting from two MA S techniques was studied and compared by measuring the circulating T lympho cyte and natural killer (NK) cell subsets. METHOD: This investigation was a randomized prospective study of patients a dmitted to the Professorial Surgical Unit, Aberdeen Royal Infirmary for ele ctive cholecystectomy. Two methods of MAS were studied-laparoscopy and mini -laparotomy, RESULTS: Laparoscopy was found to cause significantly less reduction in the number of cells expressing T lymphocyte phenotypic surface markers (CD2, C D3, CD8, CD4:CD8 ratio), activation markers (CD71 and HLA-DR), and NK cell subsets (CD11b, CD16, CD56 and CD57), when compared with the minilaparotomy technique. CONCLUSIONS: These data show that host defences are less suppressed after l aparoscopic cholecystectomy, and this may have important implications for t he use of laparoscopic techniques in major surgical resections, especially for malignant disease. Am J Surg. 1999;177:48-54, (C) 1999 by Excerpta Medi ca, Inc.