Context: COPD is a progressive, chronic inflammatory disorder that permanently reduces one's ability to breathe out during expiration. "COPD is a preventable and curable illness with some important extrapulmonary consequences that may add to the severity in individual individuals," as stated by the worldwide effort for COPD guideline (GOLD). The pulmonary (airway) restriction often worsens with time and is not completely reversible since it is linked to an inappropriate inflammatory response of the lung to unpleasant particles or gases. This article provides an overview of the different anaesthetic options available for patients with severe COPD undergoing laparoscopic procedures. The above discussion suggests that LC is not only possible under RA, but should be considered as a valid option for the patients who are poor candidates for GA, such as those with advanced COPD, because it reduces the risk of atelectasis, the impact on closing capacity and FRC, the maintenance of pulmonary gas exchange, and the duration of the postoperative recovery period.