Physiologic considerations in laparoscopic surgery

Contemporary laparoscopic surgery gained traction in the late twentieth century and continues to evolve as a mode of minimally invasive intervention in pediatric surgery. In this chapter, we outline the historic backdrop which led to the inception of laparoscopic surgery into pediatric surgery. With the advent of robotic-assisted surgery, laparoscopy continues to expand within the specialty. This chapter provides an overview of the physiologic changes seen with laparoscopic surgery and how to mitigate these changes in the operating room. Underestimating the physiologic effects of increased intraabdominal pressure, patient positioning, and gas absorption can result in deleterious outcomes. A detailed description of these effects across various organ systems including cardiac, pulmonary, renal, and the central nervous system are organized in terms of their direct and indirect effects on each of these systems. Practical points, highlighting key concepts, with actionable clinical recommendations, provide operating room personnel with the means to safely perform laparoscopic surgery in children.