Laparoscopic surgery offers numerous advantages over traditional open surgery to such an extent that it has become the gold standard for performing many surgical procedures, especially in abdominal surgery. The main benefits include less postoperative pain, shorter hospital stays, faster recovery, and better cosmetic results. However, performing the technique itself necessarily involves adapting the body to several non-physiological changes. The most important of these changes is pneumoperitoneum, created by insufflating the abdomen with carbon dioxide (CO2) to create space for the surgeon to work. Additionally, the patient often needs to be positioned in ways that facilitate the surgeon's access, which can affect hemodynamic stability. There is also a greater need for ventilation, primarily due to the absorption of CO2, and pneumoperitoneum increases intra-abdominal pressure and can reduce the functional residual capacity of the lungs. All these changes contribute to the unique clinical picture of an anesthetized patient undergoing a laparoscopic procedure. Such circumstances carry a higher risk of developing cardiac and pulmonary complications, as well as complications related to CO2 insufflation, such as hypercapnia and acidosis. Moreover, there can be disturbances in regional circulation due to increased intra-abdominal pressure. Despite these issues, considering all the pathophysiological impacts and possible complications, anesthesia in laparoscopy does not significantly differ in its basic principles from that used in open surgery. However, there are differences. Due to these differences, the skill and experience of the anesthesiologist become indispensable tools for safely conducting laparoscopic procedures. The anesthesiologist must be able to quickly recognize and manage potential complications that may require conversion to open surgery. Their role is crucial in ensuring patient safety throughout the entire procedure, from preparation to postoperative recovery.