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In laparoscopic surgery, image quality is often degraded by surgical smoke or by side effects of the illumination system, such as reflections, specularities, and non-uniform illumination. The degraded images complicate the work of the surgeons and may lead to errors in image-guided surgery. Existing enhancement algorithms mainly focus on enhancing global image contrast, overlooking local contrast. Here, we propose a new Patch Adaptive Structure Decomposition utilizing the Multi-Exposure Fusion technique to enhance the local contrast of laparoscopic images for better visualization. The set of under-exposure level images is obtained from a single input blurred image by using gamma correction. Spatial linear saturation is applied to enhance image contrast and to adjust the image saturation. The Multi-Exposure Fusion (MEF) is used on a series of multi-exposure images to obtain a single clear and smoke-free …