**1. Introduction**

26 Updated Topics in Minimally Invasive Abdominal Surgery

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High risk patients who are candidates for laparoscopic cholecystectomy differ from the patients who have no existing risks and comorbidities in terms of the methods to be used as well as the expected outcomes. In order to recognize the safety of laparoscopic cholecystectomy, different cases of high risk patients undergoing laparoscopic cholecystectomy were gathered which demonstrate their conditions during laparoscopic cholecystectomy. These articles focused on patients with cardiopulmonary diseases, diabetes mellitus, sickle cell diseases, renal diseases, liver cirrhosis, during pregnancy and in the elderly. The results of the different cases showed that laparoscopic cholecystectomy is a safe procedure to be utilized and it is therefore recommended as the treatment of choice, as long as it is done cautiously and skillfully in all the high risk groups. The consequences of this technique including the bile duct injury, influence of pneumoperitoneum on cardiorespiratory system and other complications are outweighed by the benefits that the patients acquire after the surgery.

Patients who are high risk and undergo traditional cholecystectomy carries high morbidity and mortality as compared to laparoscopic cholecystectomy. The introduction of laparoscopic cholecystectomy has decreased the number of contraindications in the past recent years and in which more studies are focused on the constant modifications in terms of the assessed risks as well as the indications for the procedure.[1]

Patients who have past or recent medical conditions who are at risk of presenting perioperative complications and those who cannot survive an operation are the ones classified as high risks patients.[2] The issue that is always brought up for patients with such conditions is whether the benefits of laparoscopic cholecystectomy offset the risks involved especially with the new methods used in the procedure such as CO2 insufflation and pneumoperitoneum.[3]

There are collated cases which demonstrate the conditions of the high risks patients during laparoscopic cholecystectomy. These articles focused on patients with cardiopulmonary diseases, diabetes mellitus, sickle cell diseases, renal diseases, liver cirrhosis, during pregnancy and in the elderly.
