title: Physiopathology and clinical considerations of laparoscopic surgery in the elderly.
abstract: OBJECTIVE
  The marked improvements in medical technology and healthcare, lead an increasing number of elderly patients to take advantage of even complex surgical. Recently, laparoscopic surgery has been accepted as a minimally invasive treatment to reduce the morbidity after conventional surgery, and a number of studies have demonstrated the feasibility of laparoscopy with significant advantages also in the elderly. On the other side, the laparoscopic procedure has some drawbacks, including prolonged operation time and impact of carbon dioxide pneumoperitoneum on circulatory and respiratory dynamics. This paper will review the physiopathological implications of laparoscopy, as well as the current literature concerning the most common laparoscopic procedures that are increasingly performed in elderly patients.
  
  
  METHODS
  A systematic review of the current literature was performed using the search engines EMBASE and PubMed to identify all studies reporting the physiopathological implications of laparoscopy in the elderly. The MeSH search terms used were "laparoscopy in the elderly", "physiopathology of laparoscopy", and "pneumoperitoneum". Multiple combinations of the keywords and MeSH terms were used with particular reference to elderly patients.
  
  
  RESULTS
  Although laparoscopy is minimally invasive in its dissection techniques, the increased physiologic demands present particular challenges among elderly patients.
  
  
  CONCLUSIONS
  Laparoscopy and its safety in the elderly patients remains a challenge and the evaluation of this approach is therefore mandatory. Although many studies have demonstrated the applicability and advantages of the laparoscopy also in the geriatric population, with low rates of morbidity and mortality, in elderly patients undergoing general surgical procedures the physiologic demands of laparoscopy should be carefully considered.
authors.affiliation: Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy. Electronic address: cagliapi@unict.it.
authors.forename: Pietro
authors.initials: P
authors.lastname: Caglià
authors.affiliation: Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy. Electronic address: traciang@unict.it.
authors.forename: Angelo
authors.initials: A
authors.lastname: Tracia
authors.affiliation: Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy. Electronic address: a.buffone@unict.it.
authors.forename: Antonino
authors.initials: A
authors.lastname: Buffone
authors.affiliation: Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy. Electronic address: luka_amod@yahoo.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Amodeo
authors.affiliation: Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy. Electronic address: lucianotracia@me.com.
authors.forename: Luciano
authors.initials: L
authors.lastname: Tracia
authors.affiliation: Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy. Electronic address: amodeo@unict.it.
authors.forename: Corrado
authors.initials: C
authors.lastname: Amodeo
authors.affiliation: Department of Medical and Surgical Sciences, Advanced Technologies "G. Ingrassia", University of Catania, Italy. Electronic address: veroux@unict.it.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Veroux
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000368:Aged; D002245:Carbon Dioxide / Q000009:adverse effects; D006299:Health Services for the Aged; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology
chemical_list: D002245:Carbon Dioxide
keywords: Elderly; Laparoscopy; Surgery