Laparoscopic surgery in pregnancy

Each year, roughly 2% of pregnant women will undergo non-obstetrical abdominal surgery. Appendicitis, symptomatic cholelithiasis and adnexal masses are some of the common diagnoses encountered. Pregnancy poses challenges in the diagnosis and surgical management of these conditions for several reasons. Since the 1990’s, laparoscopic surgery has gained popularity and in the past few years has become the standard of care for pregnant women with surgical pathologies. The advantages of laparoscopic surgery include shorter hospital stay, lower rates of wound infection, and decreased time to bowel function. This brief review discusses key points in laparoscopic surgery during pregnancy and highlights studies comparing laparoscopic and open approaches in common surgical conditions during pregnancy.     

Laparoscopic treatment of unruptured 13-week tubal pregnancy

As a rule, ectopic pregnancy localized in the uterine tube is symptomatic in the early period after implantation, and the signs of intra-abdominal hemorrhage are observed at the 4th–6th weeks of gestation. This article presents the case history of a patient who underwent successful laparoscopic salpingectomy in an unruptured 13-week tubal pregnancy. The treatment policy of advanced ectopic pregnancy is discussed herein and compared with the cases described in the previous literature.     

腹腔镜在妊娠期妇科急腹症中的应用

妊娠期急腹症分妊娠相关急腹症和非急腹症。本文对妊娠期妇科疾病所导致急腹症的类型进行复习,并且对妊娠期妇科急腹症患者腹腔镜手术技巧、围术期管理及手术对妊娠结局的影响等研究进展进行了综述,以期对妊娠期急诊腹腔镜手术的规范化应用提供指导。     

Safety of Laparoscopic Surgery for Benign Diseases during Pregnancy: A Nationwide Retrospective Cohort Study

Study Objective

To compare fetal, maternal, and operative outcomes of laparoscopic surgery versus laparotomy for major benign diseases including appendicitis, cholecystitis, adnexal masses, and uterine myoma during pregnancy.

A late post-traumatic diaphragmatic hernia revealed during pregnancy by post-partum respiratory distress

Introduction Diaphragmatic hernia during pregnancy is uncommon and is usually traumatic in origin, epigastric pain, and vomiting could be the initial symptoms of herniation of gastrointestinal contents, with a risk of strangulation and ischaemia, leading to respiratory distress due to collapse of the lung. Methods Case report. Results A 27-year-old woman, with undiagnosed traumatic diaphragmatic hernia who presented, at 32 weeks’ gestation, epigastric pain, vomiting and tachycardia, immediate post-partum course was complicated by respiratory failure. A chest X-ray showed an air fluid level in the left lung which was wrongly diagnosed as an hydropneumothorax, in front of respiratory symptoms exacerbation, an inappropriate thoracic drainage tube was accidentally placed into the herniated stomach leading to perforation of this last. An emergency laparotomy discovered a 2/3 of the stomach, transverse colon and greater omentum herniated in the left hemithorax through a defect of the left hemidiaphragm. Conclusion The diagnosis should then be considered early, and chest radiography with a nasogastric tube is the first technique to prefer and may be helpful to confirm the diagnosis.     

妇科腹腔镜手术并发症相关因素的分析

目的:探讨腹腔镜手术的并发症及其相关因素。方法:回顾性分析我院7 年中2946例腹腔镜手术病例及25例出现并发症的患者相关因素。结果:腹腔镜手术并发症的发生率为0.85%(25/2946)。因并发症而需要中转开腹手术者6例(0.2%),子宫切除术、肌瘤剔除术、附件手术及其他手术的并发症发生率分别为5.3%(7/133)、2.0%(5/246)、0.50%(11/2189)及0.53%(2/378)。穿刺及气腹有关的并发症11例(0.37%);术中并发症6例(0.28%);术后并发症8例(0.2%)。子宫切除术并发症的发生率远高于子宫肌瘤剔除手术及附件手术(P<0.01)。结论:妇科腹腔镜手术的并发症不容忽视,其并发症的发生与手术的难度有关。     

腹腔镜下治疗休克型输卵管妊娠的临床观察

目的　探讨腹腔镜手术治疗休克型异位妊娠的可行性与安全性。方法　回顾性分析我院 1996年 1月至 2 0 0 1年 1月 5年间收治的经腹腔镜手术治疗的输卵管妊娠病例 2 15例的临床资料。其中有休克症状及腹腔内出血量超过 10 0 0ml的 2 1例为研究组 ,其余 194例为对照组 ,分析两组患者围手术期情况。结果　研究组与对照组的一般情况无明显差异 ;输卵管破裂的发生率分别为 81%(17/2 1)、16% (3 1/194) ,两组比较 ,差异有极显著性 (P <0 0 1) ;腹腔内出血量分别为 (1775± 5 3 1)与(13 3± 176)ml (P <0 0 1) ,自体输血量分别为 (1141± 13 2 7)与 (2 5± 83 )ml (P <0 0 1) ,自体输血率分别为 95 %与 9% ,两组比较 ,差异均有极显著性 (P <0 0 1) ;术中出血量分别为 (40± 2 2 )与 (5 6±5 8)ml,两组比较 ,差异无显著性 (P >0 0 5 )。研究组与对照组输卵管切除术的比例分别为 86%与5 1% ,两组比较 ,差异有极显著性 (P <0 0 1) ;手术时间分别为 (5 0± 2 4)与 (43± 2 4)min ,两组比较 ,差异无显著性 (P >0 0 5 ) ;术后住院时间分别为 (3 0± 0 8)与 (2 3± 0 8)d ,两组比较 ,差异无显著性 (P>0 0 5 )。两组均无腹腔镜操作引起的围手术期并发症。结论　具备熟练的腹腔镜操作技术对休克型输卵管妊娠     

Laparoscopic management of a spontaneous 12th week heterotopic tubal pregnancy: a case report

Here we present a spontaneously-developed case involving 12th week heterotopic tubal pregnancy. In the preoperative period, the diagnosis was confirmed both by ultrasonographic examination and magnetic resonance imaging (MRI). The patient was treated successfully using a laparoscopic salpingectomy technique without jeopardizing the intrauterine pregnancy.     

Visuospatial ability correlates with performance in simulated gynecological laparoscopy

Objective

To analyze the relationship between visuospatial ability and simulated laparoscopy performed by consultants in obstetrics and gynecology (OBGYN).

Study design

This was a prospective cohort study carried out at two community hospitals in Sweden. Thirteen consultants in obstetrics and gynecology were included. They had previously independently performed 10-100 advanced laparoscopies. Participants were tested for visuospatial ability by the Mental Rotations Test version A (MRT-A). After a familiarization session and standardized instruction, all participants subsequently conducted three consecutive virtual tubal occlusions followed by three virtual salpingectomies. Performance in the simulator was measured by Total Time, Score and Ovarian Diathermy Damage. Linear regression was used to analyze the relationship between visuospatial ability and simulated laparoscopic performance. The learning curves in the simulator were assessed in order to interpret the relationship with the visuospatial ability.

Results

Visuospatial ability correlated with Total Time (r = −0.62; p = 0.03) and Score (r = 0.57; p = 0.05) in the medium level of the virtual tubal occlusion. In the technically more advanced virtual salpingectomy the visuospatial ability correlated with Total Time (r = −0.64; p = 0.02), Ovarian Diathermy Damage (r = −0.65; p = 0.02) and with overall Score (r = 0.64; p = 0.02).

Conclusions

Visuospatial ability appears to be related to the performance of gynecological laparoscopic procedures in a simulator. Testing visuospatial ability might be helpful when designing individual training programs.     

Adnexal Torsion during Pregnancy: Outcomes after Surgical Intervention—A Retrospective Case-Control Study

Study Objective

To investigate the pregnancy and neonatal outcomes of surgical treatment for adnexal torsion (AT) during pregnancy.

A 10-year experience of laparoscopic surgery for adnexal masses during pregnancy

Objective

To assess the clinicopathologic outcomes of laparoscopic surgery for adnexal masses during pregnancy.

Methods

In a retrospective study, the medical records of 88 patients who underwent laparoscopic surgery for adnexal masses during pregnancy between 2000 and 2009 were reviewed.

Results

The mean age of the study population was 30.1 years (range 21-40 years), and the mean gestational age at surgery was 11.6 weeks (4.6-23.6 weeks). The mean diameter of the mass on sonography was 7.5 cm (1.8-18 cm). Pathologically, the most common tumor was a mature cystic teratoma (35.2%), and the prevalence of malignancy was 6.8%. Emergency surgery due to torsion was performed in 28 patients (31.8%). Two spontaneous abortions occurred, both after emergency surgery. The frequency of obstetric complications, such as low birth weight, preterm delivery, use of tocolytics for preterm labor, low Apgar score, and fetal anomaly, was acceptable.

Conclusion

Laparoscopic surgery for adnexal masses during pregnancy provided tolerable outcomes for the fetus and the mother. In the future, larger prospective clinical trials are necessary to elucidate fully the impact on the fetus.     

A Prospective Matched Case-Control Study of Laparoendoscopic Single-Site vs Conventional Laparoscopic Myomectomy

Study ObjectiveTo compare operative and obstetric outcomes of laparoendoscopic single-site myomectomy (LESS-M) vs conventional laparoscopic myomectomy (LM).DesignProspective matched case-control study.SettingA university hospital and a tertiary care center.PatientsForty-five women underwent LESS-M, and 90 women underwent conventional LM.InterventionLESS-M or conventional LM.Measurements and Main ResultsOperative and obstetric outcomes. There were no significant differences between the 2 groups in demographic characteristics, operative time (135 vs 140 minutes), change in hemoglobin concentration (1.9 vs 1.95 g/dL), return of bowel activity (35 vs 28 hours), hospital stay (5 vs 5 days), or complication rate (11.1% vs 8.9%). Insofar as obstetric outcomes, no significant differences were observed between the 2 groups for duration of follow-up (24.4 vs 23.2 months), pregnancy rate in patients who desired pregnancy (66.7% vs 50.0%), full-term delivery rate (66.7% vs 58.3%), and time to first pregnancy after surgery (7.6 vs 10.1 months).ConclusionLESS-M is feasible and safe and has comparable obstetric outcomes to conventional LM in selected women with symptomatic myomas. However, a large prospective randomized study is needed.     

Laparoscopic Management of Heterotopic Istmocornual Pregnancy: A Different Technique

Study Objective

To present a modified technique for laparoscopic cornual resection for the surgical treatment of heterotopic istmocornual pregnancy.

Laparoscopic approach to interstitial pregnancy

Case report A successful laparoscopic management of an interstitial pregnancy of 42-year-old woman, treated by cornual resection was presented. The patient had an unremarkable postoperative course.Discussion The laparoscopic approach toward cornual pregnancy was presented as well as its advantages over classic laparotomy. Other techniques of conservative treatments have been reviewed.     

Surgical treatment of hepatic hydatic disease during pregnancy: report of two cases

Current treatment options for hepatic hydatid disease include surgery, medical treatment, and percutaneous drainage. However, the choice between these treatment modalities for pregnant women is still controversial. We reported in this article two pregnant patients with hepatic hydatid cysts who underwent surgical treatment.     

Surgical considerations and challenges in the pediatric and adolescent gynecologic patient

It is important for practitioners to recognize that there are special considerations when performing gynecologic surgery in a pediatric or adolescent patient. A provider must be familiar with differences in anatomy, physiology, surgical technique, and psychosocial concerns. This can be challenging for a provider who does not routinely operate on patients in this population. A minimally invasive surgical approach is preferred in the pediatric and adolescent patient whenever possible. While a good command of laparoscopy in the adult patient is certainly a useful skill when operating on pediatric and adolescent patients, there are technical adaptations and challenges to consider. This chapter reviews the pre-operative preparation, operative technique and challenges, and post-operative care of the surgical pediatric and adolescent gynecologic patient.     

Laparoscopic management of a cornual ectopic pregnancy

There are various possibilities for treating cornual ectopic pregnancies, including medical approaches using methotrexate and surgical approaches using laparoscopy. This report describes the laparoscopic management of a large cornual ectopic pregnancy associated with a high -human chorionic gonadotropin level and reviews the techniques and outcomes of conservative treatment described in the literature.