Clinical Significance of Surgical Energy Induced Biomolecular Inflammatory Response Observed in Patients Undergoing Laparoscopic Surgery – Results of a Triple Blind Randomized Study

Brij B Agarwal, MBBS, MS1, Juhil D Nanavati, MBBS1, Nayan Agarwal, MBBS, STUDENT2, Murali K Bethanbhatla, MBBS1, Neeraj Dhamija, MBBS, DNB1, Kumar Manish, MBBS1, Satish Saluja, MBBS, MD1, Naveen Sharma, MBBS, MS2, Sneh Agarwal, MBBS, MS3. 1Sir Ganga Ram Hospital & GangaRam Institute of Postgraduate Medical Education & Research, 2University College of Medical Sciences & GTB Hospital, New Delhi, 3Lady Hardinge Medical College, New Delhi

Introduction : Energized dissection (ED)  augments the proinflammatory cytokine response in patients undergoing laparoscopic surgery (LS). We have reported the adverse impact of ED on clinical outcomes following LS. We now studied the clinical significance of ED induced proinflammatory cytokine cascase.

Methods and ProceduresA Triple blind randomized study of consecutive unselected consenting candidates for day care laparoscopic cholecystectomy (LC), an index LS. Randomization by external research coordinator (blind to perioperative observations) into Group A and Group B. Standard technique of LS with or without ED followed by surgeons (blind to pre and postoperative observations) for the group allocated. Prospective data was collected for biochemical markers and clinical outcomes separately by independent nonoperative researchers (blind to operative technique) and stored in online autolocking hospital information system (HIS). Prospectively collected data for biomolecular and clinical outcomes was analysed separately by the two researchers respectively. 

STUDY POINTS – [H=Hour, D= Day, W =Week PO = Postoperative ; POP = Pain, POF = Fatigue, POS = Sleep]
Study pointMolecular / Metrics
Biomolecular (H0,H4,H24)IL6, HS-CRP, TNF-α, SGOT, SGPT, ALP, GGT, Amylase, Lipase

Clinical (D1, D3, D10, W3)

POP(100 point VAS),PONV(0-6 scale),POF(0-84 Modified Impact scale),POS(0-21Pittsburg Scale)



Prospectively collected data for biomolecular and clinical outcomes was analysed separately by the two researches respectively The access codes for entire data in HIS will be available to all the researchers next month for cross accessing the biomolecular as well as clinical outcomes and will be analysed for any correlation. The results will be presented at the meeting.

Conclusion : The results of any correlation of biomolecular inflammatory response to the clinical outcomes will be presented and discussed at the meeting.


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