Safety considerations in laparoscopic surgery: A narrative review

Table 1 Summary of various safety considerations throughout the patient journey when undergoing a laparoscopic procedure

Stage of surgery	Safety considerations
Pre-operative	Patient selection	Rule out pregnancy for elective procedures in women of child bearing age group
		Optimisation of risk factors
	Procedure selection	Elective surgery
		Emergency general surgery
		Abdominal trauma
	Pre-operative investigations	Supplementary procedures (e.g., endoscopic tattooing)
		Review of radiological investigations
Intra-operative	Before start	Effective communication and surgical check list
		Ensure correct patient, correct procedure, correct site
		Consider allergies, antibiotic prophylaxis, DVT prophylaxis, and glycaemic control
		Safe and appropriate patient positioning
		Ensure comfortable and effective laparoscopy set-up
	During surgery	Safe pneumoperitoneum and ergonomically favourable port positioning
		Use lowest possible pneumoperitoneum pressure
		Accurate selection and handling of instruments (e.g., camera, energy devices)
		Meticulous tissue dissection and haemostasis
		Regular evaluation of operative steps
		Low threshold for seeking second opinion
	At the end of the surgery	Check for haemostasis with reduced intra-abdominal pressure and adequate blood pressure
		Proper closure of port sites
Post-operative	Early recovery	Multimodal analgesia
		Thromboprophylaxis
		Clear plan for oral intake and patient’s routine medications
		Use Enhanced Recovery Protocols for elective surgery
	Complications	Early recognition of warning signs and prompt intervention
		Tachycardia not reliable as an early warning sign for patients on Beta blockers
		Appropriate training of nursing staff and early escalation. Use Early Warning Scores
	Discharge advices	Clear discharge documentation for patient and their primary care doctor
		Patient education on complications and anticipated recovery times

DVT: Deep vein thrombosis.