Elevated plasma histamine concentration as a sensitive real-time parameter for distinct phases of surgical trauma: a tool for technology assessment.

High technology plays an important role in surgery, either to expand surgical procedures or to reduce tissue trauma, which is a main goal of minimum invasive surgery. Due to the tremendous increase of costs the problem of technology assessment will not only be solved by statistical methods, but also by biomedical considerations and laboratory tests. Histamine release could be an indication for tissue trauma, which is caused directly by tissue damage or indirectly by infection or hypoxia. Therefore histamine release was investigated during different phases of operation in two clinically very important and complex situations: resection of liver metastases of colorectal carcinoma and resection of the oesophagus because of an oesophageal carcinoma. To model this situation in animal experiments, two randomized controlled studies were conducted in sheep. Traditional techniques were compared with techniques of minimum invasive surgery. Plasma histamine levels were determined at well-defined phases of the operation. Histamine release was demonstrated at distinct phases of operation indicating considerable specificity of this parameter, if sensitivity is guaranteed by advanced tests. Incision of the liver capsule by thermocauterization, liver ischaemia, tissue trauma in more extended disruption of perioesophageal tissue were causes of more extended histamine release. It is concluded that measurement of plasma histamine is a suitable indicator for discriminating between extended and minimum invasive surgery. The consequence of considering this parameter may be less complications in the post-operative period and a short hospital stay with better quality of life.