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Laparoscopic-assisted vaginal hysterectomy and the hyperglycemic response to surgery: an observational study

[L'hystérectomie vaginale avec assistance laparoscopique et la réponse hyperglycémique à l'intervention chirurgicale : une étude par observation]

Ralph Lattermann, MD^*, Thomas Schricker, MD PhD^*, Ulrich Wachter, Michael Georgieff, MD PhD and Markus Schreiber, MD

^* From the Department of Anesthesia, McGill University, Montreal, Quebec, Canada, and the
Clinic of Anesthesiology, University of Ulm, Ulm, Germany.

Address correspondence to: Dr. Thomas Schricker, Department of Anesthesia, McGill University, Royal Victoria Hospital, Room S5.05, 687 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada. Phone: 514-842-1231, ext. 5950; Fax: 514-843-1723; E-mail: mbek{at}musica.mcgill.ca

Purpose: To test the hypothesis that laparoscopic-assisted vaginal hysterectomy (LAVH) attenuates the hyperglycemic response to surgery when compared to vaginal hysterectomy (VH).

Methods: Fourteen patients received either LAVH (n=7) or VH (n=7). Whole body glucose production was measured before and three hours after surgery using [6.6–² H₂] glucose. Before, during and after the operation, plasma concentrations of glucose, insulin, glucagon, cortisol, epinephrine and norepinephrine were determined.

Results: Plasma glucose concentration increased in both groups during and after surgery showing a significantly higher value after VH than after LAVH (VH: 8.3 ± 1.4 mmol•L^–1; LAVH: 6.6 ± 0.9 mmol•L^–1, P <0.05). The postoperative increase in glucose production was comparable in both groups. While plasma concentrations of insulin and glucagon remained unchanged, intra- and postoperative plasma cortisol concentrations were significantly higher in the VH group than in the LAVH group. Plasma catecholamine concentrations significantly increased after both types of surgery to the same extent.

Conclusion: In this observational study, LAVH appears to blunt the hyperglycemic and cortisol response to surgery when compared to VH.