Abstract
Laparoscopic techniques are gradually replacing many common surgical procedures that are performed in an increasingly aging population. Laparoscopy places different physiologic demands on the body than in open surgery. PubMed was searched for evidence related to the use of laparoscopy in the elderly population to treat common surgical pathologies. Randomized trials, systematic reviews, and meta-analyses were preferred. Currently, over 40% of all surgeries performed in the U.S. are on patients older than 65 years. By the end of the 21st century, Americans are expected to live 20 years longer than the current average. However, elderly patients clearly show higher rates of surgical morbidity and mortality overall. Laparoscopic techniques show decreased wound complications, post-operative ileus, intraoperative blood loss, and reduced need for post-operative rehabilitation. In conclusion, laparoscopic surgery is safe in the elderly population and affords multiple advantages including decreased pain and convalescence. However, the physiology of laparoscopy places demands on elderly patients that typically present with more medical comorbidities.
Highlights
Physiology of LaparoscopyThe surgical requirements for laparoscopic surgery place unique physiological demands on the patient and present a distinct challenge in the elderly patient
Laparoscopic techniques are gradually replacing many common surgical procedures that are performed in an increasingly aging population
This paper will review the physiology of basic laparoscopy, as well as the current surgical literature of four common laparoscopic surgeries that are increasingly common in elderly patients
Summary
The surgical requirements for laparoscopic surgery place unique physiological demands on the patient and present a distinct challenge in the elderly patient. The insufflation of carbon dioxide gas can create acid-base disturbances, changes in blood gas balance, and alterations of cardiovascular and pulmonary physiology [5]. While most of these changes do not result in clinical significance, they can become more of a factor in patients with comorbid conditions, especially those that result in decreased cardiopulmonary reserve, as are common in elderly patients. There is an associated decrease in venous return to the heart and resulting tachycardia [5] This physiologic compensation initially produces a rise in caval pressures. Laparoscopy is minimally invasive in its dissection techniques, the increased physiologic demands discussed above present particular challenges among elderly patients
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