Pre-operative Assessment
🧑⚕️ The typical patient & work-up
- Often an elderly patient with multiple comorbidities — assess for a difficult airway, hypothermia risk & metabolic fluctuations.
- Review the treatment/drug interactions; rule out UTI; rule out significant cardio-respiratory disease and morbid obesity.
- Group & cross-match and keep blood products available (potential for significant, hard-to-access bleeding once docked).
- Identify high-risk patients for whom the steep Trendelenburg + pneumoperitoneum load may not be tolerated.
Relative Contraindications to Steep Trendelenburg / Pneumoperitoneum
Because the position and pneumoperitoneum drive the physiology, patients in whom these are dangerous may be better served by open surgery. Relative contraindications include:
Cardiac / respiratory
- Severe ischaemic or valvular heart disease — cannot tolerate the ↑ preload/afterload & myocardial demand
- Severe respiratory disease — cannot tolerate ↓ compliance & hypercarbia
Neuro / ocular / body habitus
- Raised ICP / space-occupying lesion / VP shunt
- Glaucoma / raised IOP & certain retinal disease
- Morbid obesity (compounds every respiratory & positioning problem)