The pathophysiological effects of laparoscopic and robot-assisted surgery are mainly a result of elevated intra-abdominal pressure (IAP), neuro-humoral reactions, and the positioning of the patient. Elevated IAP leads to the venous return diminishing, and the preload and cardiac output decrease. The drop in blood pressure is limited by increasing the afterload, elevated symphatico-tone and activation of the renin-angiotensin-aldosterone-system. There are few consequences with regard to hemodynamics with an IAP beneath 15 mmHg. Positioning of the patient also affects preload. Carbon dioxide is used to create a pneumoperitoneum. This gas is vasoactive and causes hypercarbia. Knowledge of and insights into the pathophysiological changes of the pneumoperitoneum is important in recognizing consequences. Patients with increased intra-cranial pressure or in shock have absolute contra-indications for laparoscopic surgery. Complications of laparoscopic surgery and pneumoperitoneum have to be recognized to avoid adverse outcomes.
