Laparoscopic abdominal surgery
Queen's Medical Centre, University Hospital Nottingham, Nottingham, NG7 2UH
Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB
Tel: 0115 9628064, Fax: 0115 9627713, E-mail: afletch2{at}ncht.trent.nhs.uk (for correspondence)
Laparoscopic surgery is now widely established. Benefits include reduced postoperative pain, improved cosmetic results and patient satisfaction, and reduced hospital stays. The range of surgical techniques is increasing in complexity and now includes cholecystectomy, adrenalectomy, nephrectomy, fundoplication, hernia repair, bowel resection and gynaecological procedures. There is also an increase in the number of emergency operations performed laparoscopically. Most patients undergoing gynaecological procedures are young and fit. However, patients undergoing gastrointestinal or emergency surgery may be sick and elderly; such patients may have significant associated co-morbidity.
Laparoscopic surgery involves insufflation of a gas (usually carbon dioxide) into the peritoneal cavity producing a pneumoperitoneum. This causes an increase in intra-abdominal pressure (IAP). Carbon dioxide is insufflated into the peritoneal cavity at a rate of 4–6 litre min–1 to a pressure of 10–20 mm Hg. The pneumoperitoneum is maintained by a constant gas flow of 200–400 ml min–1. The raised intra-abdominal pressure of the pneumoperitoneum, alteration in the patient's position and effects of carbon dioxide absorption cause changes in physiology, especially within the cardiovascular and respiratory systems. These changes, as well as direct effects of gas insufflation, may have significant effects on the patient, especially if they are elderly or have associated morbidity.