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.