Problems with Traditional Laparoscopy in Gynecology and the Rationale for the Development of a Gasless Laparoscopy Technique under Spinal Anesthesia Only without a Laparolift
DOI:
https://doi.org/10.31149/ijimm.v4i4.2871Keywords:
Laparoscopy, Gynecology, CO₂ Pneumoperitoneum, General Anesthesia, Spinal Anesthesia, Gasless Laparoscopy, Laparolift, Cardiorespiratory Complications, Postoperative Pain, Nausea and Vomiting, Regional HospitalsAbstract
Laparoscopy under general anesthesia with CO₂ pneumoperitoneum has become a recognized standard for the surgical treatment of various gynecological conditions. However, increased intra-abdominal pressure, the Trendelenburg position, carbon dioxide insufflation, and the need for tracheal intubation are accompanied by significant cardiorespiratory changes and a high drug load. This limits the safety and accessibility of laparoscopy in patients with comorbidities, pregnant women, elderly women, and in regional hospitals with insufficient anesthesia and intensive care facilities. Objective. To conduct a comprehensive analysis of the clinical, physiological, anesthesiological, and organizational-economic challenges of traditional laparoscopy in gynecology and, based on this, to justify the need to develop and implement a new method of gasless laparoscopy under spinal anesthesia without the use of a laparolift. Material and Methods. The study was conducted as a problem-based analytical review. Data from domestic and international publications on the effects of CO₂ pneumoperitoneum and general anesthesia on hemodynamics, respiration, postoperative pain, nausea, and vomiting during laparoscopic interventions in gynecology were used, as well as reports on gasless technologies and laparoscopy under regional anesthesia. Clinical observations of the use of laparoscopic interventions under spinal anesthesia in gynecological practice were also analyzed. Results Traditional laparoscopy under general anesthesia with CO₂ pneumoperitoneum has been shown to be associated with the risk of hypercapnia, increased airway pressure, systemic hemodynamic instability, a high incidence of postoperative pain, nausea, and vomiting, as well as significant demands on operating room equipment and personnel qualifications. The use of low-pressure CO₂, gas-free technologies with a laparolift, and laparoscopy under intubation anesthesia only partially reduces the severity of adverse effects. Analysis of available data and clinical observations highlights the need for a method that eliminates CO₂ pneumoperitoneum and laparolift while using intubation anesthesia and maintaining adequate pelvic visibility at zero intra-abdominal pressure. Conclusion. The combination of cardiorespiratory, anesthesiological, and organizational/economic limitations of traditional laparoscopy in gynecology justifies the need to develop a new method of gasless laparoscopy under spinal anesthesia without a laparolift.
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