Laparoscopic surgery in pregnancy
- Michael P Stany, MD
Michael P Stany, MD
- Assistant Professor
- Uniformed Services University
- Department of Obestetrics and Gynecology
- Walter Reed Army Medical Center
- John C Elkas, MD, JD
John C Elkas, MD, JD
- Associate Professor
- Inova Teaching Faculty
- Department of Obstetrics and Gynecology
- Virginia Commonwealth University
- Section Editors
- Vincenzo Berghella, MD
Vincenzo Berghella, MD
- Section Editor — Obstetrics
- Director, Maternal-Fetal Medicine
- Professor, Obstetrics and Gynecology
- Thomas Jefferson University
- David L Hepner, MD
David L Hepner, MD
- Section Editor — Obstetric Anesthesia
- Associate Professor of Anaesthesia
- Harvard Medical School
- Tommaso Falcone, MD, FRCSC, FACOG
Tommaso Falcone, MD, FRCSC, FACOG
- Section Editor — Minimally Invasive Gynecologic Surgery
- Professor of Obstetrics and Gynecology
- Cleveland Clinic Lerner College of Medicine
The advantages of laparoscopic surgery are similar for pregnant and nonpregnant women; nevertheless, this procedure had been avoided during pregnancy because of concerns that it may be harmful to the fetus. Potential concerns include:
●The rise in intra-abdominal pressure during pneumoperitoneum could decrease utero-placental blood flow and result in fetal hypoxia
●Fetal acidosis could develop from absorption of carbon dioxide (CO2)
●The fetus could be injured directly or indirectly if the uterus is perforated by a trocar or Veress needle.
●Uterine perforation may result in preterm premature rupture of the membranes and preterm delivery.
- Soriano D, Yefet Y, Seidman DS, et al. Laparoscopy versus laparotomy in the management of adnexal masses during pregnancy. Fertil Steril 1999; 71:955.
- Reedy MB, Källén B, Kuehl TJ. Laparoscopy during pregnancy: a study of five fetal outcome parameters with use of the Swedish Health Registry. Am J Obstet Gynecol 1997; 177:673.
- Pearl J, Price R, Richardson W, et al. Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc 2011; 25:3479.
- Nasioudis D, Tsilimigras D, Economopoulos KP. Laparoscopic cholecystectomy during pregnancy: A systematic review of 590 patients. Int J Surg 2016; 27:165.
- Cox TC, Huntington CR, Blair LJ, et al. Laparoscopic appendectomy and cholecystectomy versus open: a study in 1999 pregnant patients. Surg Endosc 2016; 30:593.
- Lee D, Abraham N. Laparoscopic radical nephrectomy during pregnancy: case report and review of the literature. J Endourol 2008; 22:517.
- Felbinger TW, Posner M, Eltzschig HK, Kodali BS. Laparoscopic splenectomy in a pregnant patient with immune thrombocytopenic purpura. Int J Obstet Anesth 2007; 16:281.
- Alouini S, Rida K, Mathevet P. Cervical cancer complicating pregnancy: implications of laparoscopic lymphadenectomy. Gynecol Oncol 2008; 108:472.
- Wai PY, Ruby JA, Davis KA, et al. Laparoscopic ventral hernia repair during pregnancy. Hernia 2009; 13:559.
- Affleck DG, Handrahan DL, Egger MJ, Price RR. The laparoscopic management of appendicitis and cholelithiasis during pregnancy. Am J Surg 1999; 178:523.
- Erekson EA, Brousseau EC, Dick-Biascoechea MA, et al. Maternal postoperative complications after nonobstetric antenatal surgery. J Matern Fetal Neonatal Med 2012; 25:2639.
- Conron RW Jr, Abbruzzi K, Cochrane SO, et al. Laparoscopic procedures in pregnancy. Am Surg 1999; 65:259.
- Akira S, Yamanaka A, Ishihara T, et al. Gasless laparoscopic ovarian cystectomy during pregnancy: comparison with laparotomy. Am J Obstet Gynecol 1999; 180:554.
- Andreoli M, Sayegh SK, Hoefer R, et al. Laparoscopic cholecystectomy for recurrent gallstone pancreatitis during pregnancy. South Med J 1996; 89:1114.
- Lyass S, Pikarsky A, Eisenberg VH, et al. Is laparoscopic appendectomy safe in pregnant women? Surg Endosc 2001; 15:377.
- Rojansky N, Shushan A, Fatum M. Laparoscopy versus laparotomy in pregnancy: a comparative study. J Am Assoc Gynecol Laparosc 2002; 9:108.
- Sachs A, Guglielminotti J, Miller R, et al. Risk Factors and Risk Stratification for Adverse Obstetrical Outcomes After Appendectomy or Cholecystectomy During Pregnancy. JAMA Surg 2017.
- Steinbrook RA, Bhavani-Shankar K. Hemodynamics during laparoscopic surgery in pregnancy. Anesth Analg 2001; 93:1570.
- Reedy MB, Galan HL, Bean-Lijewski JD, et al. Maternal and fetal effects of laparoscopic insufflation in the gravid baboon. J Am Assoc Gynecol Laparosc 1995; 2:399.
- Barnard JM, Chaffin D, Droste S, et al. Fetal response to carbon dioxide pneumoperitoneum in the pregnant ewe. Obstet Gynecol 1995; 85:669.
- Hunter JG, Swanstrom L, Thornburg K. Carbon dioxide pneumoperitoneum induces fetal acidosis in a pregnant ewe model. Surg Endosc 1995; 9:272.
- Uemura K, McClaine RJ, de la Fuente SG, et al. Maternal insufflation during the second trimester equivalent produces hypercapnia, acidosis, and prolonged hypoxia in fetal sheep. Anesthesiology 2004; 101:1332.
- Walsh CA, Tang T, Walsh SR. Laparoscopic versus open appendicectomy in pregnancy: a systematic review. Int J Surg 2008; 6:339.
- Wilasrusmee C, Sukrat B, McEvoy M, et al. Systematic review and meta-analysis of safety of laparoscopic versus open appendicectomy for suspected appendicitis in pregnancy. Br J Surg 2012; 99:1470.
- Walker HG, Al Samaraee A, Mills SJ, Kalbassi MR. Laparoscopic appendicectomy in pregnancy: a systematic review of the published evidence. Int J Surg 2014; 12:1235.
- Andreoli M, Servakov M, Meyers P, Mann WJ Jr. Laparoscopic surgery during pregnancy. J Am Assoc Gynecol Laparosc 1999; 6:229.
- Stepp K, Falcone T. Laparoscopy in the second trimester of pregnancy. Obstet Gynecol Clin North Am 2004; 31:485.
- Levy T, Dicker D, Shalev J, et al. Laparoscopic unwinding of hyperstimulated ischaemic ovaries during the second trimester of pregnancy. Hum Reprod 1995; 10:1478.
- Upadhyay A, Stanten S, Kazantsev G, et al. Laparoscopic management of a nonobstetric emergency in the third trimester of pregnancy. Surg Endosc 2007; 21:1344.
- Rollins MD, Chan KJ, Price RR. Laparoscopy for appendicitis and cholelithiasis during pregnancy: a new standard of care. Surg Endosc 2004; 18:237.
- Geisler JP, Rose SL, Mernitz CS, et al. Non-gynecologic laparoscopy in second and third trimester pregnancy: obstetric implications. JSLS 1998; 2:235.
- Roman H, Accoceberry M, Bolandard F, et al. Laparoscopic management of a ruptured benign dermoid cyst during advanced pregnancy. J Minim Invasive Gynecol 2005; 12:377.
- Casey FE, Lau KN, Mesbah MC, Khalife ME. Use of laparoscopy for resolution of intussusception in the third trimester of pregnancy: a case report. J Reprod Med 2009; 54:712.
- Lenglet Y, Roman H, Rabishong B, et al. [Laparoscopic management of ovarian cysts during pregnancy]. Gynecol Obstet Fertil 2006; 34:101.
- Guyatt GH, Akl EA, Crowther M, et al. Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:7S.
- Barnes SL, Shane MD, Schoemann MB, et al. Laparoscopic appendectomy after 30 weeks pregnancy: report of two cases and description of technique. Am Surg 2004; 70:733.
- Sen G, Nagabhushan JS, Joypaul V. Laparoscopic cholecystectomy in third trimester of pregnancy. J Obstet Gynaecol 2002; 22:556.
- Reedy MB, Galan HL, Richards WE, et al. Laparoscopy during pregnancy. A survey of laparoendoscopic surgeons. J Reprod Med 1997; 42:33.
- Yuen PM, Ng PS, Leung PL, Rogers MS. Outcome in laparoscopic management of persistent adnexal mass during the second trimester of pregnancy. Surg Endosc 2004; 18:1354.
- Lin YH, Hwang JL, Huang LW, Seow KM. Successful laparoscopic management of a huge ovarian tumor in the 27th week of pregnancy. A case report. J Reprod Med 2003; 48:834.
- Mathevet P, Nessah K, Dargent D, Mellier G. Laparoscopic management of adnexal masses in pregnancy: a case series. Eur J Obstet Gynecol Reprod Biol 2003; 108:217.
- Tulikangas PK, Nicklas A, Falcone T, Price LL. Anatomy of the left upper quadrant for cannula insertion. J Am Assoc Gynecol Laparosc 2000; 7:211.
- Lee YY, Kim TJ, Kim CJ, et al. Single port access laparoscopic adnexal surgery versus conventional laparoscopic adnexal surgery: a comparison of peri-operative outcomes. Eur J Obstet Gynecol Reprod Biol 2010; 151:181.
- Song T, Kim TJ, Kim MK, et al. Single port access laparoscopic-assisted vaginal hysterectomy for large uterus weighing exceeding 500 grams: technique and initial report. J Minim Invasive Gynecol 2010; 17:456.
- Kim WC, Kwon YS. Laparoendoscopic single-site surgery for exteriorization and cystectomy of an ovarian tumor during pregnancy. J Minim Invasive Gynecol 2010; 17:386.
- Garzarelli S, Mazzuca N. One laparoscopic puncture for treatment of ovarian cysts with adnexal torsion in early pregnancy. A report of two cases. J Reprod Med 1994; 39:985.
- Melgrati L, Damiani A, Franzoni G, et al. Isobaric (gasless) laparoscopic myomectomy during pregnancy. J Minim Invasive Gynecol 2005; 12:379.
- Oguri H, Taniguchi K, Fukaya T. Gasless laparoscopic management of ovarian cysts during pregnancy. Int J Gynaecol Obstet 2005; 91:258.
- Stany MP, Winter WE 3rd, Dainty L, et al. Laparoscopic exposure in obese high-risk patients with mechanical displacement of the abdominal wall. Obstet Gynecol 2004; 103:383.
- Fatum M, Rojansky N. Laparoscopic surgery during pregnancy. Obstet Gynecol Surv 2001; 56:50.
- O'Rourke N, Kodali BS. Laparoscopic surgery during pregnancy. Curr Opin Anaesthesiol 2006; 19:254.
- Kodali BS, Chandrasekhar S, Bulich LN, et al. Airway changes during labor and delivery. Anesthesiology 2008; 108:357.
- Bhavani-Shankar K, Steinbrook RA, Brooks DC, Datta S. Arterial to end-tidal carbon dioxide pressure difference during laparoscopic surgery in pregnancy. Anesthesiology 2000; 93:370.