Hemostatic changes in laparoscopic and laparotomic gynecological surgery

Abstract number: P0933

Rogolino^* A., Gori† A. M., Cellai^* A. P., Alessandrello Liotta^* A., Coccia† M. E., Bracco† G. L., Comparetto† C., Paniccia† R., Pepe† G., Abbate† R., Prisco† D.

^*Azienda Ospedaliera Careggi, Italy; †University of Florence, Italy

An increasing number of ovarian cysts are now managed laparoscopically rather than by laparotomy. Laparoscopic surgery (LPS) appears to be less traumatic to the patients than the open surgery (OS), but its influence upon coagulation and fibrinolysis in gynecology is not completely elucidated. We investigated coagulation, fibrinolysis, and endothelial activation during and after gynecological surgical procedures performed by either LPS or OS. Thrombin–anti-thrombin complexes (TAT), d-dimer, plasmin–anti-plasmin complexes (PAP), and thrombomodulin (TM) were determined in 16 women who underwent LPS and 16 women who underwent OS for ovarian cysts. Blood samples were obtained the day of surgery in the morning before the procedure (T1), 15 min after anesthesia (T2), 1 h after the start of surgery (T3), 30 min after the end of surgery (T4), 24 after the surgery (T5), and at the discharge (T6). No significant differences were observed in T1 values between LPS and OS groups for all parameters. In both groups, a statistically significant rise in TAT levels occurred, compared with T1 [LPS group: 2.3 (1.0–5.0) mg L^-1 and OS group: 2.5 (1.8–6.3) mg L^-1], from T3 [LPS group: 15.1 (4.7–53.3) mg L^-1 and OS group: 16.5 (2.9–87.7) mg L^-1] to T4 [LPS group: 8.7 (2.5–82.1) mg L^-1 and OS group: 10.8 (2.9–87.8) mg L^-1]. In LPS group, d-dimer showed a significant increase at T4 [54 (30.0–230.4) ng mL^-1] with respect to the T1 [26 (12.0–60.0) ng mL^-1], whereas in OS group a significant increase in d-dimer levels was observed at T3 [75.5 (12.0–360.0) ng mL^-1] compared with T1 [32.5 (15.0–55.0) ng mL^-1]. In both groups, a statistically significant rise in PAP levels occurred, compared with T1 [LPS group: 362 (142–567) mg L^-1 and OS group: 403 (102–597) mg L^-1], from T2 [LPS group: 430 (284–1804) mg L^-1 and OS group: 528 (226–1998) mg L^-1] to T4 [LPS group: 490 (230–1530) mg L^-1 and OS group: 531 (150–1734) mg L^-1]. In LPS group, no significant changes in TM levels were observed among the different sampling times, whereas in OS group we observed a statistically significant progressive rise in TM levels compared with T1 [15.5 (10–30) mg L^-1], from T2 [38.5 (20–79) ng mL^-1] to T2 [22.5 (15–60) ng mL^-1]. In LPS group, TM levels were significantly higher than those found in OS group both at T2 and at T3. This study indicates that a similar degree of clotting activation occurs after both, OS and LPS. However, the OS but not LPS signs of endothelial cell activation, although mild and transient were found.