Laparoscopy reduces acute phase reaction (C-reactive protein, IL-6), metabolic response (hyperglycemia, leukocytosis) compared to laparotomy.
Nitrogen balance and immune function better preserved.
Reduced intestinal exposure, peritoneal trauma.
Reduced postoperative ileus, fasting, IV infusion duration, hospital stay.
Endocrine response (cortisol, catecholamines) does not differ significantly from open surgery.
Stress response can be reduced by preoperative $\alpha_2$-agonists.

Significantly reduced pain and analgesic consumption compared to laparotomy.
Pain types: Perietal (laparotomy), visceral (laparoscopy), shoulder-tip pain (diaphragmatic irritation).
CO$_2$ insufflation causes more discomfort than N$_2$O.
Pain relief: Topical anesthetics, intraperitoneal local anesthetic, careful evacuation of residual CO$_2$, thoracic epidural analgesia, bilateral rectus sheath block.
Preoperative NSAIDs reduce pain and analgesic consumption.
Preoperative multimodal analgesia is effective.

Respiratory dysfunction is less severe and recovery quicker after laparoscopy than laparotomy.
Greater reductions in expiratory volumes in older, obese, smokers, COPD patients.
Pulmonary function still impaired, but improved compared to laparotomy.
Thoracic epidural analgesia can improve lung function.

Inert Gases (Helium, Argon):
- Avoids CO$_2$ absorption, no hypercapnia.
- Ventilatory consequences of increased IAP still persist.
- Hemodynamic changes (decreased CO, attenuated arterial pressure increase) similar to CO$_2$.
- Low blood solubility raises safety concerns for gas embolism.
Gasless Laparoscopy:
- Abdominal wall lift with a retractor, avoids pneumoperitoneum.
- Avoids hemodynamic and respiratory repercussions of increased IAP and CO$_2$.
- Renal and splanchnic perfusion not altered.
- Reduced postoperative pain, nausea, vomiting for cholecystectomy.
- Reduces port-site metastases for cancer surgery.
- Appeal for severe cardiac/pulmonary disease.
- Compromises surgical exposure, increases technical difficulty.
- Combining with low-pressure CO$_2$ pneumoperitoneum (5 mmHg) may improve conditions.

Non-obstetric procedures: Appendectomy, cholecystectomy.
Concerns: Miscarriage/preterm labor, gravid uterus damage, fetal acidosis from hypercarbia.
Recommendations:
- Second trimester (ideally before 23rd week).
- Tocolytics debated prophylactically.
- Open laparoscopy for abdominal access.
- Fetal monitoring (transvaginal US).
- Adjust mechanical ventilation for physiologic maternal alkalosis (maintain normocarbia).