The effect of training and duration of surgery on adhesion formation in the rabbit model

Abstract

In order to evaluate the effect of training upon postoperative adhesions, standard bipolar and mechanical, nonopposing injuries were performed in the uterine horns and side walls of 52 mature female rabbits using a conventional three-puncture laparoscopy, by an endoscopic surgeon with limited experience. An additional injury, either bipolar or mechanical or both, was performed in the retro-uterine space. With experience, the duration of surgery decreased progressively from 12 +/- 2 to 8 +/- 1 min in the first and last 10 animals respectively. The amount of perioperative bleeding was not affected by experience. With experience the postoperative adhesions decreased in extent (P = 0.0001), tenacity (P = 0.004), type (P = 0.002) and inflammation (P = 0.003) and for total score (P = 0.0002). These changes were correlated with the briefer duration of surgery but not with the amount of perioperative bleeding. The strong correlations of adhesion scores in the pouch of Douglas, and around both uterine horns confirmed the importance of the inter-animal variability in making adhesions. By logistic regression, the adhesions in the pouch of Douglas were explained simultaneously by the adhesions on the uterine horns (P = 0.0004, thus correcting for inter-animal variability) by the amount of bleeding (P = 0.01) and the duration of surgery (P = 0.05). No major differences were found in adhesions following a mechanical or a bipolar injury or following such a lesion in the pouch of Douglas or at the uterine horns. In conclusion, experience, expressed by the duration of surgery and to a lesser extent perioperative bleeding, is a major co-factor in postoperative adhesions, suggesting that duration of surgery should be strictly standardized in endoscopic adhesion studies. The important inter-animal variability can be circumvented by using a standard control lesion, making each animal its own control.

Stability of peritoneal tissue evaluated by the means of DSC in obese patients undergoing laparoscopic cholecystectomy

“…Carbon dioxide pneumoperitoneum affects the intraperitoneal environment and was described as a factor, which in standard conditions during short time laparoscopy, influences the peritoneum and promotes the formation of adhesions. However, heating the gas may limit this process [31][32][33][34]. Molinas et al [35] studied mice peritoneum and observed that an increased formation of adhesions correlates with the duration and pressure of pneumoperitoneum.…”

Experimental model of the formation of pelvic adhesions by videolaparoscopic in female rabbits

“…These species are excellent to quantify adhesion formation at a minimum interval of 7 days. Rabbits are an animal model that is favorable for adhesion formation, mainly because they are easily adaptable to videolaparoscopic procedures with conventional equipment, such as nephrectomies and Nissen's operation 12,13 . The fibrinolitic potential of the peritoneum is variable among animal species, and there is more plasminogen activation in the rabbit than in the rat.…”

Adhesion formation with open versus laparoscopic cholecystectomy: an immunologic and histologic study

“…After abdominal surgery, adhesion formation seems to be one of the major pathologic changes in almost all cases [12]. In comparison with open surgery, laparoscopic surgery, as a minimally invasive technique, seems to have a marked effect in the reduction of adhesion formation.…”