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Laparoscopic surgery in pregnancy

Michael P Stany, MD
John C Elkas, MD, JD
Section Editors
Vincenzo Berghella, MD
David L Hepner, MD
Tommaso Falcone, MD, FRCSC, FACOG
Deputy Editor
Kristen Eckler, MD, FACOG


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.

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Literature review current through: Nov 2017. | This topic last updated: Feb 24, 2017.
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  1. Soriano D, Yefet Y, Seidman DS, et al. Laparoscopy versus laparotomy in the management of adnexal masses during pregnancy. Fertil Steril 1999; 71:955.
  2. 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.
  3. 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.
  4. Nasioudis D, Tsilimigras D, Economopoulos KP. Laparoscopic cholecystectomy during pregnancy: A systematic review of 590 patients. Int J Surg 2016; 27:165.
  5. 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.
  6. Lee D, Abraham N. Laparoscopic radical nephrectomy during pregnancy: case report and review of the literature. J Endourol 2008; 22:517.
  7. 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.
  8. Alouini S, Rida K, Mathevet P. Cervical cancer complicating pregnancy: implications of laparoscopic lymphadenectomy. Gynecol Oncol 2008; 108:472.
  9. Wai PY, Ruby JA, Davis KA, et al. Laparoscopic ventral hernia repair during pregnancy. Hernia 2009; 13:559.
  10. Affleck DG, Handrahan DL, Egger MJ, Price RR. The laparoscopic management of appendicitis and cholelithiasis during pregnancy. Am J Surg 1999; 178:523.
  11. Erekson EA, Brousseau EC, Dick-Biascoechea MA, et al. Maternal postoperative complications after nonobstetric antenatal surgery. J Matern Fetal Neonatal Med 2012; 25:2639.
  12. Conron RW Jr, Abbruzzi K, Cochrane SO, et al. Laparoscopic procedures in pregnancy. Am Surg 1999; 65:259.
  13. Akira S, Yamanaka A, Ishihara T, et al. Gasless laparoscopic ovarian cystectomy during pregnancy: comparison with laparotomy. Am J Obstet Gynecol 1999; 180:554.
  14. Andreoli M, Sayegh SK, Hoefer R, et al. Laparoscopic cholecystectomy for recurrent gallstone pancreatitis during pregnancy. South Med J 1996; 89:1114.
  15. Lyass S, Pikarsky A, Eisenberg VH, et al. Is laparoscopic appendectomy safe in pregnant women? Surg Endosc 2001; 15:377.
  16. Rojansky N, Shushan A, Fatum M. Laparoscopy versus laparotomy in pregnancy: a comparative study. J Am Assoc Gynecol Laparosc 2002; 9:108.
  17. 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.
  18. Steinbrook RA, Bhavani-Shankar K. Hemodynamics during laparoscopic surgery in pregnancy. Anesth Analg 2001; 93:1570.
  19. 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.
  20. Barnard JM, Chaffin D, Droste S, et al. Fetal response to carbon dioxide pneumoperitoneum in the pregnant ewe. Obstet Gynecol 1995; 85:669.
  21. Hunter JG, Swanstrom L, Thornburg K. Carbon dioxide pneumoperitoneum induces fetal acidosis in a pregnant ewe model. Surg Endosc 1995; 9:272.
  22. 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.
  23. Walsh CA, Tang T, Walsh SR. Laparoscopic versus open appendicectomy in pregnancy: a systematic review. Int J Surg 2008; 6:339.
  24. 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.
  25. 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.
  26. Andreoli M, Servakov M, Meyers P, Mann WJ Jr. Laparoscopic surgery during pregnancy. J Am Assoc Gynecol Laparosc 1999; 6:229.
  27. Stepp K, Falcone T. Laparoscopy in the second trimester of pregnancy. Obstet Gynecol Clin North Am 2004; 31:485.
  28. 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.
  29. 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.
  30. Rollins MD, Chan KJ, Price RR. Laparoscopy for appendicitis and cholelithiasis during pregnancy: a new standard of care. Surg Endosc 2004; 18:237.
  31. Geisler JP, Rose SL, Mernitz CS, et al. Non-gynecologic laparoscopy in second and third trimester pregnancy: obstetric implications. JSLS 1998; 2:235.
  32. 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.
  33. 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.
  34. Lenglet Y, Roman H, Rabishong B, et al. [Laparoscopic management of ovarian cysts during pregnancy]. Gynecol Obstet Fertil 2006; 34:101.
  35. 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.
  36. 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.
  37. Sen G, Nagabhushan JS, Joypaul V. Laparoscopic cholecystectomy in third trimester of pregnancy. J Obstet Gynaecol 2002; 22:556.
  38. Reedy MB, Galan HL, Richards WE, et al. Laparoscopy during pregnancy. A survey of laparoendoscopic surgeons. J Reprod Med 1997; 42:33.
  39. 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.
  40. 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.
  41. 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.
  42. 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.
  43. 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.
  44. 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.
  45. 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.
  46. 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.
  47. Melgrati L, Damiani A, Franzoni G, et al. Isobaric (gasless) laparoscopic myomectomy during pregnancy. J Minim Invasive Gynecol 2005; 12:379.
  48. Oguri H, Taniguchi K, Fukaya T. Gasless laparoscopic management of ovarian cysts during pregnancy. Int J Gynaecol Obstet 2005; 91:258.
  49. 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.
  50. Fatum M, Rojansky N. Laparoscopic surgery during pregnancy. Obstet Gynecol Surv 2001; 56:50.
  51. O'Rourke N, Kodali BS. Laparoscopic surgery during pregnancy. Curr Opin Anaesthesiol 2006; 19:254.
  52. Kodali BS, Chandrasekhar S, Bulich LN, et al. Airway changes during labor and delivery. Anesthesiology 2008; 108:357.
  53. 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.