Anesthetic Management of Minimally Invasive Gynecological Surgery

Abstract

Minimally invasive gynecological surgeries are widely used nowadays. These include both laparoscopic and hytersoscopic procedures for both diagnostic and therapeutic purposes. The anestheiologists must be aware of their benefits, hazards and complications of minimally invasive gynecological surgeries. Although minimally invasive gynecologic surgeries have several advantages such as reduced analgesic requirements and shorter hospital stay, they are not the optimal choice for all patient groups as they still carry several disadvantages related to the consequences of raised intraabdominal pressure, patient positioning and pneumoperitonium. Hence, they are contraindicated in patient with severe increase in intracranial tension, severe cardiorespiratory compromise, or ventilation perfusion mismatch. Careful and thorough preoperative assessment of the patients is of utmost importance to the anesthesiologist to detect patient suitability for the procedure and thus minimize its hazards. Recently, spinal, epidural anesthesia have been widely implicated for minimally invasive gynecological surgery with a good outcome comparable to that of general anesthesia.Also infiltration of local anesthesia (mesosalpnix douglas pouch block, and rectus sheath block have been successfully used to reduce postoperative pain. Gasless laparoscopy is one of the most recent minimally invasive gynecological surgeries where the no CO2 inflation of the abdominal cavity is used while using lifting system for good exposure of the intra-abdominal organs. This technique has decreased the incidence of complications associated with pneumoperotinium where the occurrence of respiratory restriction, hypercapnia, gas embolism, and other complications has been markedly reduced.