Laparoscopic surgery, also called minimally invasive surgery or keyhole surgery, is a modern surgical technique in which operations are performed through small incisions (usually measuring 0.5–1.5 cm), which are made through the skin and tissues to allow access to the required internal site.

Laparoscopy is a type of surgical procedure that allows a surgeon to access the inside of the abdomen and pelvis without having to make large incisions in the skin. It involves the introduction of a number of small ports through the skin to allow access into the abdominal cavity (Figure 16.18). Specialized cameras, lights and instruments are introduced through these ports in order to perform this minimally invasive surgery.

Laparoscopy involves the insufflation of the abdomen with carbon dioxide. This is necessary in order to expand the space in which the surgeon is operating to facilitate the surgery, and is known as ‘pneumoperitoneum’ (Figure 16.18). Carbon dioxide is used because unlike air or oxygen is does not support combustion in the presence of electricity and is readily excreted by the patient's respiratory system. However, it is not without risk as carbon dioxide absorption may be associated with adverse events such as hypercapnia and acidosis (T. Yu et al. [238]). Prolonged insufflation may also lead to hypothermia (Mason et al. [119]) as the gas flow causes the temperature in the abdomen to decrease. Surgical emphysema is also a risk when a large volume of carbon dioxide is used for a long procedure. Careful monitoring and recording of the patient's vital signs, including oxygen saturation and expiratory gas levels, are therefore essential during laparoscopic surgery.

It is important to carefully evaluate patients with known or suspected pulmonary disease prior to undertaking a laparoscopic procedure, as pneumoperitoneum and hypercarbia may be poorly tolerated. It is important to determine the baseline PaCO₂ (partial pressure of carbon dioxide) in patients with known pulmonary disease so that the extent of hyperventilation can be better evaluated intraoperatively (see Chapter c12: Respiratory care, CPR and blood transfusion and Chapter c14: Observations).

Electrosurgery is the application of a high‐frequency (radio frequency) alternating‐polarity electrical current to biological tissue as a means to cut, coagulate, desiccate or fulgurate tissue. Electrosurgery complications during laparoscopic surgery are primarily related to the number of instruments and cannulas within the operative field (AfPP [9]). The principal hazards associated with these procedures are: