Awake laparoscopic surgery under combined spinal-epidural anesthesia: a consecutive series of 52 patients across multiple general surgical procedures.

BACKGROUND

General anesthesia (GA) remains the standard anesthetic technique for laparoscopic surgery; however, alternative anesthetic approaches may be considered in selected patients with significant comorbidities or severe anxiety related to GA. We evaluated the feasibility and observed perioperative outcomes of awake laparoscopic surgery performed under a standardized combined spinal-epidural (CSE) anesthesia protocol across multiple general surgical procedures.

METHODS

We conducted a retrospective single-center case series of consecutive patients undergoing laparoscopic surgery under CSE anesthesia between September 2017 and August 2026. All procedures were performed by the same experienced laparoscopic surgeon and senior anesthesiologist using a standardized multidisciplinary protocol. The primary outcome was successful completion of the laparoscopic procedure without conversion to GA. Secondary outcomes included conversion to open surgery, postoperative complications, length of hospital stay, 30 day readmission, and mortality.

RESULTS

Fifty-two patients were included; the mean age was 62.2 ± 19.0 years, 32 (61.5%) were male, and 29 (55.8%) were ASA physical status III. Forty-four patients (84.6%) had at least one comorbidity. Procedures included laparoscopic cholecystectomy (n = 33), inguinal hernia repair (n = 10), sleeve gastrectomy (n = 6), appendectomy (n = 2), and ventral hernia repair (n = 1). Fifty procedures (96.2%) were completed without conversion to GA. Two patients (3.8%) required conversion to GA, and one (1.9%) required conversion to open surgery without GA. Postoperative complications occurred in five patients (9.6%), including one Clavien-Dindo grade IVa complication. Median hospital stay was 1 day (IQR, 1-1). There were no 30-day readmissions or deaths.

CONCLUSION

Laparoscopic surgery under CSE anesthesia appears feasible in carefully selected patients when performed by an experienced multidisciplinary team using a standardized perioperative protocol. The technique was successfully applied across multiple general surgical laparoscopic procedures and patients with varying degrees of anesthetic risk, with a 96.2% completion rate without conversion to GA. Prospective controlled multicenter studies are warranted to further evaluate comparative safety, procedure-specific outcomes, and optimal patient selection.