What are the key aspects of laparoscopic surgery?

From the Guidelines

Laparoscopic surgery should be considered a viable option for emergency procedures, with proper precautions taken to minimize the risk of viral transmission and exposure to aerosolized particles, as recommended by recent guidelines 1.

Key Elements of Laparoscopic Surgery

The key elements of laparoscopic surgery include:

• Equipment required, such as laparoscopes, trocars, insufflation devices, and specialized instruments
• Carbon dioxide used to create pneumoperitoneum at pressures of 12-15 mmHg to create working space
• Common laparoscopic procedures, including cholecystectomy, appendectomy, hernia repair, and gynecological surgeries
• Advantages, such as smaller incisions, less pain, reduced blood loss, shorter hospital stays, and faster recovery
• Potential complications, including vascular or bowel injury during trocar insertion, gas embolism, and physiological effects of pneumoperitoneum

Precautions for Laparoscopic Surgery during COVID-19 Pandemic

Precautions for laparoscopic surgery during the COVID-19 pandemic include:

• Limiting the leakage of gas
• Using constant pressure insufflators to reduce the aerosol effect of insufflation
• Using central aspirator systems to drain the smoke
• Implementing smoke evacuation/suction and minimizing energy device/electrocautery use
• Wearing personal protective equipment (PPE) to prevent occupational exposure

Recent Guidelines and Recommendations

Recent guidelines and recommendations for laparoscopic surgery include:

• The ERAS® Society consensus guidelines for emergency laparotomy, which recommend an enhanced recovery after surgery approach 1
• The importance of organizational aspects of care, including end-of-life issues, and the need for further evaluation of components of care for emergency laparotomy patients 1

From the Research

Overview of Laparoscopic Surgery

• Laparoscopic surgery is a minimally invasive technique that offers many benefits, including attenuation of surgical wound pain 2
• The main advantage of laparoscopic surgery is the use of small incisions, which reduces the risk of postoperative complications 2

Pain Management in Laparoscopic Surgery

• Early pain after laparoscopy can be similar or even more severe than that after open surgery, and proactive pain management should be provided 3
• A multimodal, preventive analgesia approach, such as combining opioids with non-opioid analgesics and local anaesthetics, is most effective in controlling pain 3
• Wound and port site local anaesthetic injections can decrease abdominal wall pain by 1-1.5 units on a 0-10 pain scale 3
• Acetaminophen can be used as a baseline analgesic for postoperative pain management, and it has been shown to be safe and effective in laparoscopic colorectal surgery 2
• IV ibuprofen has been shown to be effective in reducing pain scores and opioid consumption compared to acetaminophen in patients undergoing laparoscopic cholecystectomy surgery 4

Antibiotic Prophylaxis in Laparoscopic Surgery

• The use of prophylactic antibiotics in gynecologic laparoscopic surgery is still popular, but studies have shown that it may not be necessary in elective laparoscopic surgery for benign gynecologic conditions 5
• A study found that postoperative infection complications in laparoscopic gynecologic surgery without antimicrobial prophylaxis are negligible and overlapping to those obtained with cefazolin prophylaxis 5

Complications and Instrumentation in Laparoscopic Surgery

• Laparoscopic surgery requires additional instrumentation and skills, as well as familiarity with a number of operative complications unique to laparoscopy 6
• The basic equipment and instrumentation of laparoscopy, as well as its possible associated complications, should be understood by surgeons performing laparoscopic procedures 6