Laparoscopic Surgery In Pregnancy Research Articles

Emergency laparoscopic surgery in pregnancy

Introduction: The decision to proceed with surgical intervention is often difficult in pregnant women, particularly in emergency contexts. Opting for laparoscopic surgery in pregnant women is even more challenging. Concerns during laparoscopic procedures include potential fetal injury, reduced uterine blood flow due to pneumoperitoneum, and fetal acidosis. The objective of our study is to evaluate the feasibility and morbidity-mortality of emergency laparoscopy in pregnant women. Materials and Methods: This is a descriptive and prospective study conducted between February 2018 and October 2021, involving 337 patients who underwent laparoscopic surgery for acute non-traumatic abdominal emergencies. Results: Among the 190 female patients operated on, 18 patients (9.47%) were pregnant: 8 (44.5%) had acute appendicitis, 7 (38.9%) had acute lithiasic cholecystitis, 2 (11.2%) had ovarian cyst torsion, and 1 (5.6%) had an appendiceal abscess. This laparoscopic management was performed across different gestational ages. The mean gestational age of our patients was 15 ± 14 weeks of amenorrhea (minimum 7 weeks, maximum 29 weeks). The mean operative time for the surgical interventions in these pregnant women was 61.2 minutes ± 20.16 minutes. No intraoperative complications or incidents, no conversions, and no abortions were recorded. Conclusion: Laparoscopy can be safely used to manage acute non-traumatic abdominal emergencies during pregnancy.

Operative management of acute cholecystitis in pregnancy: Case report

Introduction: Acute cholecystitis is the second most common non-obstetric surgical disease during pregnancy. There have been several trials comparing operative and non-operative management in the past. Purpose: To present a clinical case from our practice and to compare clinical management with worldwide standards. Materials and methods: A 42-year-old patient in the 20th gestational week presented to our department with complaints of pain in the epigastrium and RUQ, as well as a single incidence of vomiting, during the last two days. Results: We operated 15 h after admission and did a standard laparoscopy. The patient was discharged on the 4th postoperative day. Conclusion: A review of the available literature shows the prevalence of early laparoscopic cholecystectomy, while non-operative management has proven to have higher complication rates. Laparoscopic surgery in pregnancy has proven to be safe for both mother and fetus. In our case, the patient was operated on within the first 24 hours of admission. We did not observe any complications during her stay and follow-up.

Laparoscopic ovarian cystectomy in the gravid patient

To demonstrate safety and efficacy of laparoscopic surgery in pregnancy while describing specific surgical techniques employed in this particular population. The surgery was performed at an academic affiliated community hospital. The patient was a 24 year old G2P1001 at 17 weeks gestation undergoing laparoscopic surgical management of ovarian torsion with a 12 cm ovarian dermoid cyst. We performed a laparoscopic ovarian cystectomy and detorsion of an ovary in a gravid patient in the second trimester. Laparoscopic surgery is safe and feasible during pregnancy. Entry using an open approach with a multiport device may enhance safety and minimize the need for placement of multiple assistant trocars. Given adnexal hypervascularity, delicate tissue handling and aggressive hemostasis is of utmost importance. It is beneficial for even experienced surgeons to refamiliarize themselves with laparoscopy in pregnancy prior to performing these operations.

Laparoscopy in Pregnancy: A Primer

Study Objective To present principles and techniques for safe and efficient laparoscopic surgery during pregnancy. Design Stepwise demonstration of techniques with narrated video footage. Setting Laparoscopic surgery during pregnancy is safe and effective with an associated miscarriage rate of 1.3%. When feasible, it should be performed early in the 2nd trimester. In this video, we review key principles and techniques to safely perform laparoscopic surgery during pregnancy. Patients or Participants A 34-year-old female at 18 weeks 4 days gestation presents with a 7 cm ovarian mass causing right lower quadrant (RLQ) pelvic pain. Interventions The key principles for safe and effective laparoscopic surgery during pregnancy include: Measurements and Main Results The patient recovered well without any obstetrical or postoperative complications. Conclusion When performing laparoscopic surgery in pregnancy, a surgeon should remember these key perioperative modifications for a safe and efficient procedure.

Laparoscopy in the gynecological acute abdomen in pregnancy

Acute abdomen in pregnancy can be divided into pregnancy-related and non-pregnancy-related type. This article reviewed the different types of acute abdomen caused by gynecological problems during pregnancy. Also, the progress of laparoscopic surgical technique and the perioperative management and the influence of the operation on pregnancy outcomes in patients who developed acute abdomen and underwent laparoscopic surgery in pregnancy were also analyzed, to provide information for the application of emergency laparoscopic surgery in pregnancy. Key words: Abdomen, acute; Pregnancy complications; Laparoscopy

Laparoscopic Surgery in Pregnancy and Consequences According to Gestational Age

Laparoscopic Surgery in Pregnancy and Consequences According to Gestational Age

Laparoscopic Surgery in Pregnancy and Consequences According to Gestational Age

Laparoscopic Surgery in Pregnancy and Consequences According to Gestational Age

Laparoscopic surgery in pregnancy

Laparoscopic surgery in pregnancy

The use of laparoscopic surgery in pregnancy: evaluation of safety and efficacy

Background Laparoscopic surgery in pregnant women has become increasingly more common since the 1990s; however, the safety of laparoscopy in this population has been widely debated, particularly in emergent and urgent situations. Methods A retrospective chart review of all pregnant women following a nonobstetric abdominal operation at a University hospital between 1993 and 2007. Perioperative morbidity and mortality for the mother and fetus were evaluated. Results Ninety-four subjects were identified; 53 underwent laparoscopic procedures and 41 underwent open procedures. Cholecystectomy and appendectomy were performed in both groups with salpingectomy/ovarian cystectomy only in the laparoscopic group. No maternal deaths occurred, while fetal loss occurred in 3 cases within 7 days of the operation and in 1 case 7 weeks postoperatively. This and other perinatal complications occurred in 36.7% of the laparoscopic group and 41.7% of the open group. Conclusion Laparoscopic appendectomy and cholecystectomy appear to be as safe as the respective open procedures in pregnant patients; however, this population in particular remains at risk for perinatal complications regardless of the method of abdominal access.

Laparoscopy in Pregnancy

The first laparoscopic surgery in pregnancy was a cholecystectomy in 1991. Since that time, a number of articles and case series have been published addressing laparoscopy in pregnancy. Current recommendations are on the basis of these findings, such as operating during any trimester in pregnancy can be safely performed, fetal heart monitoring should be made preoperatively and postoperatively, prophylactic tocolytics should not be used, and multiple entry techniques (Veress needle, Hasson trocar, or optical trocar) can be safely performed. This article will review anesthesia, fetal effects, obesity, complications, adnexal masses, and gastrointestinal issues.

Laparoscopic appendectomy in pregnant patients: a review of 45 cases

Laparoscopic surgery in pregnancy remains debated, especially in cases of suspected appendicitis. Cases of suspected appendicitis treated by the laparoscopic approach in a single institution over a 10-year period were reviewed (1997-2007). The objectives were to evaluate the immediate complications of the procedure and the outcome of pregnancies including foetal loss and preterm delivery. Retrospective analysis of 45 consecutive cases of suspected appendicitis during pregnancy was carried out. Forty-two patients (93%) had a preoperative ultrasound, of which 13 (33%) confirmed an acute appendicitis. Out of 45 cases, 15 (33%) had the surgical procedure during the first trimester, 22 (49%) in the second and 8 (18%) in the third. Two (4%) patients had major complications (intra-abdominal abscess and uterine perforation) and two others (4%) had minor complications (cystitis and ileus). No patients underwent delivery in the month following surgery and there was no foetal loss in the follow-up. Three (8.1%) patients delivered prior to 35 weeks' gestation and 18.1% delivered before term (<37 weeks). As previously reported, a high rate of normal appendix (33%) was found at surgery. No significant differences were found in rates of preterm delivery, adverse outcome or operative time between trimesters of pregnancy at the time of surgery. Mean operative time was 49 +/- 19 min. This large series from a single institution shows a low rate of preterm delivery and absence of foetal loss after laparoscopic appendectomy. Regardless of trimester, the low rate of complication makes it a valuable option for pregnant patients with suspicion of acute appendicitis. The rate of normal appendectomies remaining high, efforts have to be made towards new diagnostic modalities to lower the negative appendectomy rate in this specific population.

Safety and Efficacy of Laparoscopic Surgery in Pregnancy: Experience of a Single Institution

We report all the procedures performed in pregnant patients in our institute. There were 2 cases of laparoscopic mesh repair (for posterolateral diaphragmatic Bochdalek hernia and laparoscopic Heller cardiomyotomy) and 1 laparoscopic cystectomy for torsion of an ovarian cyst; 7 laparoscopic appendectomies (6 for acute appendicitis and 1 for perforated appendix); and 9 laparoscopic cholecystectomies (8 for acute cholecystitis and 1 for gallbladder empyema). All these patients were in their second trimester of pregnancy. All the laparoscopic procedures were successful: there was no mortality, morbidity, or conversions. There were no complications for either mother or child related to general anesthesia. The changes in physiology of the pregnant patient have to be adequately addressed and proper precautions taken to ensure safety. The second trimester is the ideal time to do laparoscopic surgery, though procedures have been performed in all trimesters. Our initial experience is satisfactory, although more data are essential to standardize laparoscopic procedures in pregnancy. We conclude that laparoscopic surgery is proving to be as safe as open surgery in pregnancy.

Laparoscopic surgery during pregnancy

In the past decade, laparoscopic procedures have become increasingly popular owing to decreased morbidity and convalescence compared with open procedures. The purpose of this review is to evaluate recent literature on laparoscopic surgery in pregnancy and make recommendations for anesthesia based on understanding of physiology of carbon dioxide pneumoperitoneum. Increasing numbers of successful cases of laparoscopic surgery are being reported. For reasons unknown, the results obtained in sheep studies do not match the observations in humans. Maternal respiratory acidosis, a common finding in sheep studies during CO2 pneumoperitoneum has not been observed in pregnant women undergoing laparoscopic surgery. A recent finding of persisting fetal sheep hypoxia beyond the duration of CO2 pneumoperitoneum calls for further investigation to determine if this finding is limited to sheep akin to sheep maternal respiratory acidosis. Present evidence suggests laparoscopic surgery in pregnancy is a safe option. Left uterine displacement, maintaining end-tidal carbon dioxide between 32-34 mmHg and maternal blood pressures within 20% of baseline, and limiting abdominal insufflation pressure of carbon dioxide to 12-15 mmHg are essential hallmarks of anesthesia procedure. Although no apparent long time consequences have been reported, further studies are necessary to confirm the validity of sheep fetal hypoxia studies.

Safety and risks of laparoscopy in pregnancy.

The purpose of this review is to evaluate the indications, and the safety and efficacy of operative laparoscopy in pregnancy with a particular attention to the pregnancy outcome. Hemodynamics changes during laparoscopic surgery in pregnancy are similar to those observed in the nonpregnant state. The procedure appears to be safe and reduces hospital admissions and frequency of premature labor. The safest time to perform laparoscopic surgery in pregnancy is at the second trimester. However, it can be complicated by injury to the gravid uterus and pregnancy loss. This is illustrated by a recent report of accidental gas insufflation into the amniotic cavity leading to the fetal loss. The most common indications of laparoscopy in pregnancy are cholelithiasis, appendicitis, persistent ovarian cyst and adnexal torsion. In general, it is associated with a good maternal and fetal outcome. The occurrence of a miscarriage, premature labor or fetal death appears to be related to the underlying pathology, independent of the operative intervention. Due to the displacement of the appendix by the gravid uterus and the physiologic elevation of white blood cell count in pregnancy, diagnosis of appendicitis in pregnancy can be delayed with its sequelle. In one report, the incidence of fetal loss is 1.5% in uncomplicated appendicitis and 35% in the presence of ruptured appendicitis. Similarly, the fetal loss rate in uncomplicated cholecystectomy is 4%, but the fetal mortality in gallstone pacreatitis could be up to 60%. Laparoscopy in pregnancy should be performed with utmost care. In the second trimester of pregnancy, open laparoscopic approach is strongly recommended.

Hemodynamics During Laparoscopic Surgery in Pregnancy

During laparoscopic cholecystectomy in four pregnant women, we observed hemodynamic changes similar to those in nonpregnant patients (i.e., decreases in cardiac index together with increases in mean arterial blood pressure and systemic vascular resistance).

Arterial to End-Tidal Carbon Dioxide Pressure Difference During Laparoscopic Surgery in Pregnancy

Arterial to End-Tidal Carbon Dioxide Pressure Difference During Laparoscopic Surgery in Pregnancy

Laparoscopic surgery in pregnancy - Is invasive monitoring essential?

Laparoscopic surgery in pregnancy - Is invasive monitoring essential?