Laparoscopy has gained wide acceptance rapidly, making it difficult for surgeons to keep abreast of the continual advances. Initially performed on healthy young patients, the perceived advantages of laparoscopy included minimal trauma, better pain control, and improved cosmesis, as compared with open procedures. The spectrum of indications widened rapidly, and soon elderly patients and ill patients with sepsis also were being approached laparoscopically. With this came the realization that the advantages of the less invasive aspects of laparoscopic surgery were accompanied by the yet unproven effects from the pathophysiology of the induced pneumoperitoneum. Although most agree regarding advantages of minimal access surgery, consensus is lacking on the consequences of the induced pneumoperitoneum. Several of the laparoscopy- related complications result from pneumoperitoneum. Therefore, the title "minimal access surgery" may be more appropriate than "minimally invasive surgery." Relative contraindications and some absolute contraindications to laparoscopic procedures have disappeared. The threshold for performing laparoscopic surgery also has been lowered for several conditions, perhaps mostly because of a novel technique's availability. This chapter elaborates on the spectrum of physiologic effects from pneumoperitoneum used during laparoscopic surgery, which result from the combined effects of pneumoperitoneum mechanics and the metabolic qualities of the gas used. Although alternative gases have been proposed, carbon dioxide remains the standard gas of choice.
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