Principles

Overall advantages with laparoscopic procedures

• Decreased postoperative pain

• Shorter duration of postoperative ileus

• Earlier discharge

• More rapid recovery

• Patient satisfaction

• Improved cosmesis

As noted by Sir Alfred Cusheri, the advantage of laparoscopic procedures is directly related to incisional trauma and those proceedures where the incision is the most traumatic event in the case will have the greater advantage.

The ideal gas for laparoscopy is one that is inert, water-soluble, and noncombus-tible.

Although no gas meets all of these criteria, CO2 is commonly used, because it is water-soluble and noncombustible.

CO2 is not inert, because it is rapidly absorbed and alters many physiologic parameters (Table 17.1).

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