Laparoscopic Management of Pelvic Pathology During Pregnancy

Linda M. Nicoll; Camran Nezhat

Disclosures

Expert Rev of Obstet Gynecol. 2009;4(1):53-60. 

In This Article

Abstract and Introduction

The following article presents an overview of current practices in laparoscopy for pelvic pathology during pregnancy. It includes a review of physiologic changes in pregnancy. Common indications for surgery during pregnancy, including adnexal masses, appendicitis and biliary disease are discussed. Recommendations for the safe practice of laparoscopy in pregnancy including timing and operative techniques are provided.

Nonobstetric surgery is performed in 1.6-2.2% of pregnant women, comprising approximately 50,000 cases per year in the USA.[1] Operative laparoscopy is becoming increasingly popular owing to the low postoperative morbidity and minimally invasive nature of procedures.[2] It has been associated with more rapid return of bowel function, decreased postoperative incisional pain, reduced requirement for pain medications and lower morbidity from atelectasis and thromboembolic events.[1] It is therefore not surprising that the laparoscopic approach in the pregnant patient is gaining acceptance as the method of choice for treating a variety of conditions, including adnexal masses, heterotopic pregnancy, appendicitis and cholecystitis. Additional indications for laparoscopic surgery in pregnancy have included adrenal tumors, splenic and renal disorders and abdominal pain of unknown etiology.[3] However, concern exists for the specific challenges of performing surgery on the pregnant patient. Namely, the effects of anesthesia, pneumoperitoneum, instrumentation and positioning must be carefully considered. This article reviews current indications and recommendations for laparoscopy in the pregnant patient.

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