Risks Associated with Laparoscopic Surgery

Laparoscopic surgical (LS) procedures aim to achieve a satisfactory therapeutic result while minimizing the traumatic and metabolic stress of the intervention. Tissue trauma is significantly less than that with conventional open procedures, thus results in the additional benefit of reduced post-operative pain. Other advantages of LS procedures include smaller incisional sites, lower risks of wound complications, reduced postoperative pain and complications, shorter hospital stay, more rapid return to normal activities, and cost savings (Carther, 2011; Nicholsen, 2011; Leonard & Cunningham, 2002). Despite these advantages, laparoscopic surgery may result in serious complications due to the important physiologic changes which occur during the procedure. In complicated surgical cases of extended duration, the prolonged steep head-down position and carbon dioxide insufflation results in a pneumoperitoneum which often has adverse haemodynamic and respiratory consequences (Russoa et al., 2009). Negative aspects of laparoscopic surgery in terms of the surgical procedure itself include poor visualization and traumatic injuries to viscera and blood vessels associated with blind trocar insertion. The physiologic changes associated with laparoscopy include those associated with tilting the patient to facilitate instrumentation and surgical exposure, the pressure effects of instilled gas into a closed cavity, and the systemic effects of the gas, almost universally CO2, that is instilled (and absorbed or embolized). Initially performed in healthy patients, laparoscopy is now used for complicated gastrointestinal (eg. distal gastrectomy for gastric cancer patients with comorbid diseases, laparoscopic hepatic resection for colorectal cancer liver metastases, and laparoscopic resection or debulking of presacral and retrorectal space tumors) and genitourinary procedures. (Russoa et al., 2009).