To the Editors:

Abstract

The recent report by Platek et al. (Platek DN, Henderson CE, Goldberg GL. The management of a persistent adnexal mass in pregnancy. Am J Obstet Gynecol 1995;173:1236-40) suggesting an algorithm for the management of an adnexal mass complicating pregnancy is an important discussion of a major clinical problem. Because the incidental finding of an adnexal mass in pregnancy is becoming more common as a result of the technologic advances in ultrasonography, clinicians are often faced with this dilemma. According to the algorithm suggested by the authors, laparoscopies performed during pregnancy were mentioned; however, they were not formally discussed in the text. Review of our own experience revealed 43 patients with a persistent adnexal mass complicating pregnancy. Among these, eight diagnostic laparoscopies (18.6%) were performed during pregnancy as first-line treatment. Seven of these provided adequate exposure and a correct diagnosis of the adnexal mass. In one patient the laparoscopy failed because of the large uterus (early seventeenth week), which interfered with visualization of the pelvic organs. None of the laparoscopic procedures caused morbidity to the fetus or the mother. According to our experience and that of others,1, 2 as laparoscopic equipment, technique, and experience is getting more familiar to the surgeon, we suggest increasing the role of laparoscopic surgery arm in the algorithm suggested by Platek et al. When surgical intervention is indicated, diagnostic and therapeutic laparoscopy should be considered as an effective first modality for the management of an adnexal mass complicating pregnancy as far as the sixteenth week of gestation. Beyond this gestational age, or earlier in the case of multiple gestation, the size of the uterus is a technical obstacle forcing us to use laparotomy as the primary surgical procedure. 6/8/73591