Published online May 6, 2023. doi: 10.12998/wjcc.v11.i13.3002
Peer-review started: September 14, 2022
First decision: October 12, 2022
Revised: October 21, 2022
Accepted: November 10, 2022
Article in press: November 10, 2022
Published online: May 6, 2023
Processing time: 223 Days and 1.7 Hours
Laparoscopic cholecystectomy (LC) is one of the most widely practiced surgical procedures in abdominal surgery. Patients undergo LC during general anaesthesia; however, in recent years, several studies have suggested the ability to perform LC in patients who are awake. We report a case of awake LC and a literature review.
A 69-year-old patient with severe pulmonary disease affected by cholelithiasis was scheduled for LC under regional anaesthesia. We first performed peridural anaesthesia at the T8-T9 level and then spinal anaesthesia at the T12-L1 level. The procedure was managed in total comfort for both the patient and the surgeon. The intra-abdominal pressure was 8 mmHg. The patient remained stable throughout the procedure, and the postoperative course was uneventful.
Evidence has warranted the safe use of spinal and epidural anaesthesia, with minimal side effects easily managed with medications. Regional anaesthesia in selected patients may provide some advantages over general anaesthesia, such as no airway manipulation, maintenance of spontaneous breathing, effective postoperative analgesia, less nausea and vomiting, and early recovery. However, this technique for LC is not widely used in Europe; this is the first case reported in Italy in the literature. Regional anaesthesia is feasible and safe in performing some types of laparoscopic procedures. Further studies should be carried out to introduce this type of anaesthesia in routine clinical practice.
Core Tip: We present the first Italian case of awake laparoscopic cholecystectomy (LC) in a patient with severe pulmonary disease. The use of regional anesthesia during LC is safe, with minimal side effects, and may provide advantages over general anesthesia.