Published online Oct 21, 2014. doi: 10.3748/wjg.v20.i39.14308
Revised: March 12, 2014
Accepted: June 14, 2014
Published online: October 21, 2014
Processing time: 326 Days and 3.9 Hours
The introduction of laparoscopy in the surgeon’s armamentarium was in fact a “revolution in the history of surgery”. Since this technique involves insufflation of carbon dioxide it produces several pathophysiological changes which have to be understood by the anaesthesiologist who can modify the anaesthesia technique accordingly. Advantages of laparoscopy include reduced pain, small scars and early return to work. Certain complications specific to laparoscopic surgery are due to carboperitoneum and increased intra-abdominal pressure. Venous air embolism, although very rare, can be lethal if not managed promptly. Other complications include subcutaneous emphysema, haemodynamic compromise and arrhythmias. Although associated with minimal postoperative morbidity, postoperative pain, nausea and vomiting can be quite problematic. The limitations of laparoscopy have been overcome by the introduction of robotic surgery. There are important implications for the anaesthesiologist during robotic surgeries which have to be practiced accordingly. Robotic surgery has a learning curve for both the surgeon and the anaesthesiologist. The robot is bulky, and cannot be disengaged after docking. Therefore it is important that the anaesthetized patient remains immobile throughout surgery and anaesthesia is reversed only after the robot has been disengaged at the end of surgery. Advances in laparoscopy and robotic surgery have modified anaesthetic techniques too.
Core tip: Laparoscopy is the gold standard for cholecystectomy. The layman may perceive laparoscopy as “minimally invasive”, but the procedure has profound effects on the physiology of the patient. The surgeon and anaesthesiologist must be well versed with these pathophysiological changes so that the safety of the patient is not compromised. Robotic assisted laparoscopic surgeries are gaining popularity; here the role of the anaesthesiologist is paramount. Anaesthesiologists must fine-tune their anaesthetic techniques to meet the specific requirements of such operations.