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Anesthesia for laparoscopic and abdominal robotic surgery in adults

Author
Girish P Joshi, MB, BS, MD, FFARCSI
Section Editor
Stephanie B Jones, MD
Deputy Editor
Marianna Crowley, MD

INTRODUCTION

The laparoscopic approach has become a standard of care for many abdominal surgical procedures. Compared with laparotomy, laparoscopy can reduce postoperative pain, result in shorter recovery time, allow smaller incisions, and reduce the postoperative stress response. Laparoscopy requires insufflation of intraperitoneal or extraperitoneal gas, usually carbon dioxide (CO2), to create space for visualization and surgical maneuvers.

Robotic surgery is usually performed laparoscopically and is commonly used for gynecologic and urologic surgery.

Anesthetic concerns for patients undergoing laparoscopic and robotic surgery differ from those for patients undergoing open abdominal surgery. They include the physiologic effects of the pneumoperitoneum, absorption of CO2, and positioning required for surgery. In addition, some laparoscopic procedures take longer than the open alternative.

This topic will discuss the anesthetic management of patients having laparoscopic and robotic abdominal surgery. Advantages and disadvantages of laparoscopy and robotic surgery, technical aspects of these techniques, and surgical complications are discussed separately. (See "Robot-assisted laparoscopy" and "Complications of laparoscopic surgery" and "Instruments and devices used in laparoscopic surgery" and "Laparoscopic cholecystectomy".)

SURGICAL TECHNIQUES

Laparoscopy requires creation of a pneumoperitoneum by insufflation of gas, usually carbon dioxide (CO2), to open space in the abdomen for visualization and allow surgical manipulation. CO2 insufflation can be performed blindly using a Veress needle or by placement of a port under direct vision through a small subumbilical incision. The gas source is connected to the needle or port; intraabdominal pressure (IAP) is monitored as gas is insufflated, aiming for a pressure ≤15 mmHg to minimize physiologic effects. For laparoscopic prostatectomy, which is performed in steep Trendelenburg position, the European Association for Endoscopic Surgery recommends IAP below 12 mmHg [1].

                               

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Literature review current through: Nov 2016. | This topic last updated: Tue Nov 15 00:00:00 GMT+00:00 2016.
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