Laparoscopic surgery

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What are the benefits of minimally invasive procedures?

Improvements in scope technology have allowed many procedures to be performed without large surgical incisions, affording the patient rapid recovery of function, less postoperative pain and analgesic requirements, improved postoperative pulmonary function, smaller incisions, fewer wound infections, decreased postoperative ileus, decreased length of hospitalization, and a more rapid resumption of normal daily activities.

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What are some currently practiced minimally invasive procedures?

• General surgery: Gastrectomy, colectomy, cholecystectomy, appendectomy, pancreatectomy, splenectomy, hepatectomy, adrenalectomy, hernia repairs, diagnostic laparoscopy, gastric bypass, gastric banding, Nissen fundoplication, feeding tube placement.

• Gynecological procedures: Hysterectomy, tubal ligation, pelvic lymph node dissection, hysteroscopy, myomectomy, oophorectomy, and laser ablation of endometriosis.

• Thoracoscopic procedure/video-assisted thoracic surgery: Lobectomy, pneumonectomy, wedge resection, drainage of pleural effusions and pleurodesis, evaluation of pulmonary trauma, resection of solitary pulmonary nodules, tumor staging, repair of esophageal perforations, pleural biopsy, excision of mediastinal masses, transthoracic sympathectomy, pericardiocentesis, and pericardiectomy.

• Cardiac surgery: Coronary artery bypass and valve repair.

• Orthopedics: Various joint procedures.

• Urological procedures: Laparoscopic nephrectomy, pyeloplasty, orchiopexy, cystoscopy/ureteroscopy, and prostatectomy.

• Neurosurgery: Ventriculoscopy, microendoscopic discectomy, spinal fusion, and image-guided techniques to approach masses/tumors easily.

The focus of this chapter will be the physiological concerns associated with abdominal laparoscopy because they are common operations with profound effects on physiology.

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Are there any contraindications for laparoscopic procedures?

Relative contraindications for laparoscopy include increased intracranial pressure, patients with ventriculoperitoneal or peritoneal-jugular shunts, hypovolemia, congestive heart failure, severe cardiopulmonary disease or coagulopathy.

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Why has carbon dioxide become the insufflation gas of choice during laparoscopy?

The ideal gas would be physiologically inert, colorless, inflammable, and capable of undergoing pulmonary excretion ( Table 60.1 ). The choice of an insufflating gas for the creation of pneumoperitoneum, pneumothorax, etc., is influenced by the blood solubility of the gas, tissue permeability, combustibility, expense, and potential to cause side effects. Carbon dioxide (CO ₂ ) has become the gas of choice because it offers the best compromise between its advantages and disadvantages.

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