PubMed · 7266433
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U Obermöller, M Böhm, K H Höhne. 1981. Functional images from serial computer tomograms.. https://pubmed.ncbi.nlm.nih.gov/7266433/
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The short-term benefits of minimal access techniques include less pain, early mobilization, and shorter hospital stay. Nonetheless, significant data have accumulated regarding the complications associated with laparoscopic techniques, including those that are unique to laparoscopic surgery such as bile duct injury and disruption of major blood vessels. Other problems such as myocardial ischemia and respiratory acidosis are associated with the cardiopulmonary effects of pneumoperitoneum and systemic CO2 absorption. These physiologic changes, although tolerated by healthy patients, could have particular adverse consequences for infirm and critically ill patients. It would appear that minimizing IAP during insufflation decreases the risk of potentially marked cardiovascular changes and regional blood flow alterations. In turn, this could arguably decrease the risk of perioperative myocardial events, or organ dysfunction or failure. Laparoscopy in the critically ill patient is questionable because the role is not established. An ICU patient has little to gain from the benefits of early mobilization. Conversely, in the presence of raised ICP or borderline organ function, the physiologic changes associated with pneumoperitoneum and laparoscopy could have profound detrimental effects.
Despite the obvious benefits of minimally invasive surgery, the physiologic changes associated with thoracoscopic procedures present multiple challenges. The lung is the site of gaseous exchange, but during thoracoscopic surgery it is simultaneously either the surgical target organ or responsible for obscuring surgical exposure. Thus, there is a conflict of interests between the need to provide ideal surgical conditions and the need to maintain normal pulmonary and cardiovascular physiology. In an attempt to minimize the physiologic insult associated with thoracoscopic surgery, multiple anesthetic and surgical techniques have therefore been developed. None are entirely problem free, however. Because the physiologic changes are technique specific, a clear understanding of the dynamic interaction between the anesthetic-surgical technique and patient physiology is essential.