INTRODUCTION
Outpatient surgery, defined as the surgical patient being admitted and
discharged on the same day or within 24 hours, is accountable for
undoubted benefits such as satisfying patient preference to recover at
home, lowering the risk of nosocomial infection, providing
cost-effectiveness, and earlier mobilization1,2. The
pursuit of accomplishing “ day surgery” is one of the main goals of
any surgeon3.
Laparoscopic procedures are commonly described as “minimally invasive”
and the word minimal is attributed to surgical trauma, pain,
hospitalization interval, scar.
Regional anesthesia (RA) from an anesthesiology perspective is the
“minimally invasive technique” to achieve anesthesia. General
anesthesia (GA) is the most common and used technique for laparoscopic
procedures however, it is responsible for different adverse effects in
the postoperative period including the need for rescue analgesics, and
antiemetics4,5. Moreover, one of the main concerns
observed in a patient scheduled for GA is preoperative anxiety. It can
be generated for the fear of the unconscious state, losing control as
well as the fear of awakening during the procedure. In addition, GA is
in the collective imagination, synonymous with major surgical procedures
and invasive high-risk surgeries 6,7. RA for the
operative laparoscopic procedure has been largely applied for
cholecystectomy procedures. It results in less surgical stress response,
postoperative pain, lower incidence of postoperative nausea and
vomiting, and rapid bowel canalization8. However, as
regards the gynecological domain, evidence about the outcomes of
laparoscopy in RA are scarce. Trendelenburg procedure required for the
gynecological procedure, worsening pulmonary compliance and generating
discomfort for the patient, appears to be a great limit for the
application of this technique9. Surgical gynecological
procedures, under RA, are currently limited to diagnostic laparoscopy
adnexectomy, ablation of endometriotic foci, and
adhesiolysis10,11. Only one case report on total
laparoscopic hysterectomy is reported in the
literature12.
The aim of our study was to assess the feasibility and the
intraoperative and postoperative outcome of laparoscopic gynecological
surgery under RA compared GA from the point of view of the surgeon,
anesthesiologist and patient.