Anaesthesia for Laparoscopic Surgery An Overview
Ahmed Abdel-Atty Sayed Hassan;
Abstract
Laparoscopicsurgery(keyholesurgery)isa relativelymodernsurgicaltechniqueinwhichoperationsintheabdomenareperformedthroughsmallincisions(usually0.5–1.5cm).
Laparoscopictechniquesoffermajorbenefitstothepatientsuchasminimizedincisionsizeandtraumawithreducedpostoperativediscomfort,shortenedrecoveryrates,andalowerincidenceofpostoperativewoundinfections.Thesefactorsallcontributetoshorterin-patientstayandreducedperioperativemorbidity.Consequently,manymajorproceduresthatoncerequiredprolongedpostoperativerecoverysuchasanteriorresectionoftherectumorradicalcystectomyarenowincreasinglyperformedusinglaparoscopictechniquestoimprovepatientoutcomes.
In1910,Jacobeuspresentedthefirstseriesoflaparoscopiesinhumans.HeusedNitzecystoscopewith"coldburning"lampsandcannulawithvalvesystem.Goetzepresentedthefirstautomaticspring-loadedneedleforinitiatingpneumoperitoneumin1930s.In1938,Veressdevelopedamodifiedspring-loadedneedletosafelyintroduceairintothethoraciccavity.In1980,thefirstlaparoscopicappendicectomyandcholecystectomywasperformedbySemmandMuherespectively.Theadventoflaparoscopiccholecystectomywasthesinglemostimportantstimulustotheexpansionofoperativelaparoscopyinsurgery.
Laparoscopic surgeries are either diagnostic or therapeutic. Diagnostic laparoscopy is used in staging cancers, acute and chronic conditions such as infertility and liver disease. Therapeutic laparoscopic procedures can be divided into intra-abdominal (e.g., cholecystectomy, appendicectomy and adrenalectomy)and gynaecological (e.g., ectopic pregnancy and hysterectomy).
Laparoscopyhasitsownrisksasvisceralandvasculardamage,complicationsassociatedwithextremesofpositioning,cardiocerebralvascularinsufficiency,pulmonaryatelectasis,venousgasembolismandwelllegcompartmentsyndrome.
Therearegeneralcontraindications to laparoscopic surgery whichincludepre-existingraisedICP,severeuncorrectedhypovolaemiaandpatientswithknownright-to-leftcardiacshuntandothercontraindications areischaemicheartdisease,valvulardisease,significantrenaldysfunctionorendstagerespiratorydisease.
Duringlaparoscopy,thepatientisplacedinavarietyofpositionsinordertomaximizethesurgicalvisualfieldandfacilitateinstrumentation.Thehead-down(Trendlenburg)positioningiscommonlyusedingynaecologicaloperations,prostatectomyandcolorectalprocedures. Reverse Trendlenburgposition as well as lithotomy and lateral decubitus position are used. Each position has its adverse effects.
Laparoscopictechniquesoffermajorbenefitstothepatientsuchasminimizedincisionsizeandtraumawithreducedpostoperativediscomfort,shortenedrecoveryrates,andalowerincidenceofpostoperativewoundinfections.Thesefactorsallcontributetoshorterin-patientstayandreducedperioperativemorbidity.Consequently,manymajorproceduresthatoncerequiredprolongedpostoperativerecoverysuchasanteriorresectionoftherectumorradicalcystectomyarenowincreasinglyperformedusinglaparoscopictechniquestoimprovepatientoutcomes.
In1910,Jacobeuspresentedthefirstseriesoflaparoscopiesinhumans.HeusedNitzecystoscopewith"coldburning"lampsandcannulawithvalvesystem.Goetzepresentedthefirstautomaticspring-loadedneedleforinitiatingpneumoperitoneumin1930s.In1938,Veressdevelopedamodifiedspring-loadedneedletosafelyintroduceairintothethoraciccavity.In1980,thefirstlaparoscopicappendicectomyandcholecystectomywasperformedbySemmandMuherespectively.Theadventoflaparoscopiccholecystectomywasthesinglemostimportantstimulustotheexpansionofoperativelaparoscopyinsurgery.
Laparoscopic surgeries are either diagnostic or therapeutic. Diagnostic laparoscopy is used in staging cancers, acute and chronic conditions such as infertility and liver disease. Therapeutic laparoscopic procedures can be divided into intra-abdominal (e.g., cholecystectomy, appendicectomy and adrenalectomy)and gynaecological (e.g., ectopic pregnancy and hysterectomy).
Laparoscopyhasitsownrisksasvisceralandvasculardamage,complicationsassociatedwithextremesofpositioning,cardiocerebralvascularinsufficiency,pulmonaryatelectasis,venousgasembolismandwelllegcompartmentsyndrome.
Therearegeneralcontraindications to laparoscopic surgery whichincludepre-existingraisedICP,severeuncorrectedhypovolaemiaandpatientswithknownright-to-leftcardiacshuntandothercontraindications areischaemicheartdisease,valvulardisease,significantrenaldysfunctionorendstagerespiratorydisease.
Duringlaparoscopy,thepatientisplacedinavarietyofpositionsinordertomaximizethesurgicalvisualfieldandfacilitateinstrumentation.Thehead-down(Trendlenburg)positioningiscommonlyusedingynaecologicaloperations,prostatectomyandcolorectalprocedures. Reverse Trendlenburgposition as well as lithotomy and lateral decubitus position are used. Each position has its adverse effects.
Other data
| Title | Anaesthesia for Laparoscopic Surgery An Overview | Other Titles | تخديرحالات المناظيرالجراحية تقييم شامل | Authors | Ahmed Abdel-Atty Sayed Hassan | Issue Date | 2015 |
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