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 (PASD-MEF) technique to enhance the local contrast of laparoscopic images for better visualization. The set of under-exposure level images are 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 fused image. MEF is applied by using adaptive structure decomposition on all image patches. Image entropy based on the texture energy is used to calculate image energy strength. The texture entropy energy determined the patch size that is useful in the decomposition of image structure. The proposed method effectively eliminate smoke and enhance the degraded laparoscopic images. The qualitative results showed that the visual quality of the resultant images is improved and smoke-free. Furthermore, the quantitative scores computed of the metrics: FADE, Blur, JNBM, and Edge Intensity are significantly improved as compared to other existing methods.