Safe Approaches to Laparoscopy in the 3rd Trimester of Pregnancy

Abstract

<h3>Study Objective</h3> To review to preoperative, intraoperative, and post-operative considerations to optimize laparoscopic surgical care of the pregnant patient. <h3>Design</h3> Review of current recommendations for surgical care of pregnant patients followed by demonstration of technique with narrated video footage. <h3>Setting</h3> Non-obstetric surgery is performed in 1: 200-500 pregnant women in the US annually. As surgeons have gain more experience with laparoscopy it has become the preferred surgical route in pregnancy and can be performed at any gestational age. Anatomic and physiologic changes of pregnancy requite modifications to laparoscopic technique to optimize outcomes for both the mother and fetus. We demonstrate a case of laparoscopy on a patient at 28 weeks gestational age who presented with ovarian torsion. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> Salpingo-oophorectomy for ovarian torsion during pregnancy at 28w gestational age. <h3>Measurements and Main Results</h3> This video highlights the laparoscopic approach to salpingo-oophorectomy for ovarian torsion with key strategies for patient positioning, port placement in the gravid patient, visualization with the gravid uterus, and intraoperative fetal monitoring. 1. Patient positioning with left lateral tilt and deflection of the uterus for left upper quadrant entry point 2. Supraumbilical entry at the left upper quadrant using the Veress needle 3. Reduced force for trocar placement 4. Laparoscopic retraction of the gravid uterus to identify the ureter 5. Intraoperative fetal monitoring via intermittent transabdominal fetal cardiac ultrasound. <h3>Conclusion</h3> Laparoscopy can be safely preformed in pregnancy, even at advanced gestational ages. In this video we review pre-operative, intraoperative and post-operative management to optimize maternal and fetal outcomes and demonstrate intraoperative technique to minimize risks of laparoscopy in the pregnant patient.