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Kurashina R, Akira S, Kaseki H, Suzuki S. Gasless laparoscopic ovarian cystectomy for pregnant women. HYPERTENSION RESEARCH IN PREGNANCY 2022. [DOI: 10.14390/jsshp.hrp2021-015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Shigeo Akira
- Department of Obstetrics and Gynecology, Nippon Medical School
| | - Hanako Kaseki
- Department of Obstetrics and Gynecology, Nippon Medical School
| | - Shunji Suzuki
- Department of Obstetrics and Gynecology, Nippon Medical School
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2
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Aruparayil N, Bolton W, Mishra A, Bains L, Gnanaraj J, King R, Ensor T, King N, Jayne D, Shinkins B. Clinical effectiveness of gasless laparoscopic surgery for abdominal conditions: systematic review and meta-analysis. Surg Endosc 2021; 35:6427-6437. [PMID: 34398284 PMCID: PMC8599349 DOI: 10.1007/s00464-021-08677-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/07/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND In high-income countries, laparoscopic surgery is the preferred approach for many abdominal conditions. Conventional laparoscopy is a complex intervention that is challenging to adopt and implement in low resource settings. This systematic review and meta-analysis evaluate the clinical effectiveness of gasless laparoscopy compared to conventional laparoscopy with CO2 pneumoperitoneum and open surgery for general surgery and gynaecological procedures. METHODS A search of the MEDLINE, EMBASE, Global Health, AJOL databases and Cochrane Library was performed from inception to January 2021. All randomised (RCTs) and comparative cohort (non-RCTs) studies comparing gasless laparoscopy with open surgery or conventional laparoscopy were included. The primary outcomes were mortality, conversion rates and intraoperative complications. SECONDARY OUTCOMES operative times and length of stay. The inverse variance random-effects model was used to synthesise data. RESULTS 63 studies were included: 41 RCTs and 22 non-RCTs (3,620 patients). No procedure-related deaths were reported in the studies. For gasless vs conventional laparoscopy there was no difference in intraoperative complications for general RR 1.04 [CI 0.45-2.40] or gynaecological surgery RR 0.66 [0.14-3.13]. In the gasless laparoscopy group, the conversion rates for gynaecological surgery were high RR 11.72 [CI 2.26-60.87] when compared to conventional laparoscopy. For gasless vs open surgery, the operative times were longer for gasless surgery in general surgery RCT group MD (mean difference) 10 [CI 0.64, 19.36], but significantly shorter in the gynaecology RCT group MD - 18.74 [CI - 29.23, - 8.26]. For gasless laparoscopy vs open surgery non-RCT, the length of stay was shorter for gasless laparoscopy in general surgery MD - 3.94 [CI - 5.93, - 1.95] and gynaecology MD - 1.75 [CI - 2.64, - 0.86]. Overall GRADE assessment for RCTs and Non-RCTs was very low. CONCLUSION Gasless laparoscopy has advantages for selective general and gynaecological procedures and may have a vital role to play in low resource settings.
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Affiliation(s)
- N Aruparayil
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK. .,NIHR Global Health Research Group, Surgical Technologies, Clinical Sciences Building, Level 7, Room 7.19, Leeds, LS9 7TF, UK.
| | - W Bolton
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.,NIHR Global Health Research Group, Surgical Technologies, Clinical Sciences Building, Level 7, Room 7.19, Leeds, LS9 7TF, UK
| | - A Mishra
- Maulana Azad Medical College, Delhi, India
| | - L Bains
- Maulana Azad Medical College, Delhi, India
| | | | - R King
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.,NIHR Global Health Research Group, Surgical Technologies, Clinical Sciences Building, Level 7, Room 7.19, Leeds, LS9 7TF, UK
| | - T Ensor
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.,NIHR Global Health Research Group, Surgical Technologies, Clinical Sciences Building, Level 7, Room 7.19, Leeds, LS9 7TF, UK
| | - N King
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - D Jayne
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.,NIHR Global Health Research Group, Surgical Technologies, Clinical Sciences Building, Level 7, Room 7.19, Leeds, LS9 7TF, UK
| | - B Shinkins
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.,NIHR Global Health Research Group, Surgical Technologies, Clinical Sciences Building, Level 7, Room 7.19, Leeds, LS9 7TF, UK
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3
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Cagino K, Li X, Thomas C, Delgado D, Christos P, Acholonu U. Surgical Management of Adnexal Masses in Pregnancy: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2021; 28:1171-1182.e2. [PMID: 33515746 DOI: 10.1016/j.jmig.2021.01.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The incidence of adnexal masses in pregnancy is 1% to 6%. Although surgery is often indicated, there are no definitive management guidelines. We aimed to investigate the optimal approach to surgical management of adnexal masses in pregnancy on the basis of a meta-analysis of previous studies. DATA SOURCES We performed a systematic review using MEDLINE, Embase, Cochrane Library, and Clinicaltrials.gov from inception to July 17, 2020. METHODS OF STUDY SELECTION There were no restrictions on study type, language, or publication date. Comparative and noncomparative retrospective studies that reviewed operative techniques used in surgery of adnexal masses in pregnancy were included. Meta-analyses were performed to assess outcomes. This study was registered in the International Prospective Register of Systematic Reviews (CRD42019129709). TABULATION, INTEGRATION, AND RESULTS Comparative studies were identified for laparoscopy vs laparotomy and elective vs emergent surgery (11 and 4, respectively). Elective surgery is defined as a scheduled antepartum procedure. For laparoscopy vs laparotomy, the mean maternal ages and gestational ages at time of surgery were similar (27.8 years vs 27.7 years, p = .85; 16.2 weeks in laparoscopy vs 15.4 weeks in laparotomy, p = .59). Mass size was larger in those undergoing laparotomy (mean 8.8 cm vs 7.8 cm, p = .03). The most common pathologic condition was dermoid cyst (36%), and the risk of discovering a malignant tumor was 1%. Laparoscopy was not associated with a statistically increased risk of spontaneous abortion (SAB) or preterm delivery (PTD) (odds ratio [OR] 1.53; 95% confidence interval [CI], 0.67-3.52; p = .31 and OR 0.95; 95% CI, 0.47-1.89; p = .88, respectively). The mean length of hospital stay was 2.5 days after laparoscopy vs 5.3 days after laparotomy (p <.001). The decrease in estimated blood loss in laparoscopy was not statistically significant (94.0 mL in laparotomy vs 54.0 mL in laparoscopy, p = .06). Operative times were similar in laparoscopy and laparotomy (80.0 minutes vs 72.5 minutes, p = .09). Elective surgery was associated with a decreased risk of PTD (OR 0.13; 95% CI, 0.04-0.48; p = .05). Noncomparative studies were identified for laparoscopy and laparotomy. Laparotomy had more SABs and PTDs than laparoscopy (pooled proportion = 0.02 vs 0.07 and pooled proportion = 0.02 vs 0.14, respectively). CONCLUSION Laparoscopy for the surgical management of adnexal masses in pregnancy is associated with shorter length of hospital stay and similar risk of SAB or PTD. Elective surgery is associated with a decreased risk of PTD.
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Affiliation(s)
- Kristen Cagino
- Department of Obstetrics and Gynecology (Drs. Cagino, Li, and Acholonu, Jr).
| | - Xuan Li
- Department of Obstetrics and Gynecology (Drs. Cagino, Li, and Acholonu, Jr)
| | - Charlene Thomas
- Department of Population Health Sciences (Dr. Christos and Ms. Thomas)
| | - Diana Delgado
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center (Ms. Delgado), NewYork-Presbyterian Weill Cornell Medical Center, New York, New York
| | - Paul Christos
- Department of Population Health Sciences (Dr. Christos and Ms. Thomas)
| | - Uchenna Acholonu
- Department of Obstetrics and Gynecology (Drs. Cagino, Li, and Acholonu, Jr)
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Ye P, Zhao N, Shu J, Shen H, Wang Y, Chen L, Yan X. Laparoscopy versus open surgery for adnexal masses in pregnancy: a meta-analytic review. Arch Gynecol Obstet 2019; 299:625-634. [PMID: 30706184 PMCID: PMC6394438 DOI: 10.1007/s00404-018-05039-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/22/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE The objective of this meta-analysis is to investigate and compare the pregnancy outcomes of laparoscopy and open surgery in the treatment of ovarian tumors during pregnancy. METHODS Search was conducted using MEDLINE, EMBASE, and Cochrane Databases from January 1990 to November 2018. A broad search strategy was used to identify studies comparing laparoscopy and open surgery in pregnancy. Inclusion criteria included comparative studies with the quantitative outcome data on gravida. Two authors independently reviewed and assessed for the quality of included studies according to the Newcastle-Ottawa Scale. Data were extracted for fetal loss, preterm delivery, duration of surgery, blood loss and length of hospital stay. RESULTS Nine retrospective trials were identified involving 985 patients. No statistical significance was found in fetal loss between laparoscopy and open surgery (P value = 0.334). The pooled estimate for preterm labor statistically significantly decreased for laparoscopy group (P value = 0.014). Reduced operative blood loss was found in laparoscopy group by 83.81 ml (P value = 0.015). Duration of operation may be longer in the laparoscopy group, but without statistical significance (P value = 0.346). Length of hospital stay was shorter in the laparoscopy group with reduction of 1.95 days (P value < 0.001). CONCLUSIONS The available low-grade evidence suggests that laparoscopic surgery might be a feasible alternative for pregnant women with adnexal masses.
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Affiliation(s)
- Piaopiao Ye
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Na Zhao
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Jing Shu
- Department of Gynecology, Zhejiang Provincial People's Hospital, Hangzhou, 310014, China
| | - Heping Shen
- Department of Gynecology, Zhejiang Provincial People's Hospital, Hangzhou, 310014, China
| | - Yanpeng Wang
- Department of Gynecology, Zhejiang Provincial People's Hospital, Hangzhou, 310014, China
| | - Lifeng Chen
- Department of Gynecology, Zhejiang Provincial People's Hospital, Hangzhou, 310014, China
| | - Xiaojian Yan
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
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Sachs A, Guglielminotti J, Miller R, Landau R, Smiley R, Li G. Risk Factors and Risk Stratification for Adverse Obstetrical Outcomes After Appendectomy or Cholecystectomy During Pregnancy. JAMA Surg 2017; 152:436-441. [PMID: 28114513 PMCID: PMC5831452 DOI: 10.1001/jamasurg.2016.5045] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/16/2016] [Indexed: 11/14/2022]
Abstract
Importance Identification of risk factors for adverse obstetrical outcomes after appendectomy and cholecystectomy during pregnancy is necessary for evidence-based risk reduction and adequate patient counseling. Objectives To identify risk factors for adverse obstetrical outcomes after appendectomy and cholecystectomy during pregnancy and stratify the risk of such outcomes. Design, Setting, and Participants A cohort study was conducted using the Nationwide Inpatient Sample, a nationally representative sample of patients discharged from community hospitals in the United States, from January 1, 2003, to December 31, 2012. Multivariable analysis of risk factors for adverse obstetric outcomes was performed for 19 926 women undergoing appendectomy or cholecystectomy during pregnancy and a scoring system for such risk factors was developed. Data analysis was conducted from January 1, 2015, to July 31, 2016. Main Outcomes and Measures A composite measure including 7 adverse obstetrical outcomes throughout pregnancy and occurring before hospital discharge. Results Of the 19 926 women (mean [SD] age, 26 [6] years) in the study, 1018 adverse obstetrical events were recorded in 953 pregnant women (4.8%). The 3 most frequent adverse events were preterm delivery (360 [35.4%]), preterm labor without preterm delivery (269 [26.4%]), and miscarriage (262 [25.7%]). The risk factors associated most strongly with an adverse obstetrical outcome included cervical incompetence (adjusted odds ratio, 24.29; 95% CI, 7.48-78.81), preterm labor during current pregnancy (adjusted odds ratio, 18.34; 95% CI, 4.95-67.96), vaginitis or vulvovaginitis (adjusted odds ratio, 5.17; 95% CI, 2.19-12.23), and sepsis (adjusted odds ratio, 3.39; 95% CI, 2.08-5.51). A scoring system based on statistically significant variables classified the study sample into 3 risk groups corresponding to predicted probabilities of adverse obstetrical outcomes of 2.5% (≤4 points), 8.2% (5-8 points), and 21.8% (≥9 points). Conclusions and Relevance Approximately 5% of women experience adverse obstetrical outcomes after appendectomy or cholecystectomy during pregnancy. The major risk factors for such outcomes are cervical incompetence, preterm labor during current pregnancy, vaginitis or vulvovaginitis, and sepsis.
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Affiliation(s)
- Adam Sachs
- Department of Anesthesiology, Hartford Hospital, Hartford, Connecticut
- Department of Anesthesiology, University of Connecticut School of Medicine, Farmington
| | - Jean Guglielminotti
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1137, Infection, Antimicrobiens, Modélisation, Evolution, Paris, France
| | - Russell Miller
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Ruth Landau
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Richard Smiley
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Guohua Li
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
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Liu YX, Zhang Y, Huang JF, Wang L. Meta-analysis comparing the safety of laparoscopic and open surgical approaches for suspected adnexal mass during the second trimester. Int J Gynaecol Obstet 2016; 136:272-279. [PMID: 28099685 DOI: 10.1002/ijgo.12069] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/15/2016] [Accepted: 11/23/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND The safety of laparoscopic surgery during the second trimester of pregnancy remains a controversial subject. OBJECTIVES To compare the safety of laparoscopic surgery and laparotomy for suspected adnexal mass during the second trimester. SEARCH STRATEGY Articles published in any language prior to April 31, 2016, were retrieved from PubMed, Scopus, EMBSCO, and the Cochrane Library using keywords including pregnant, adnexal mass, laparoscopy, laparotomy, pregnancy outcomes, and surgical outcomes. SELECTION CRITERIA Randomized and non-randomized controlled trials reporting at least one obstetric or surgical outcome were included if they compared laparoscopic surgery and laparotomy for adnexal masses during the second trimester. DATA COLLECTION AND ANALYSIS Data were independently extracted by two reviewers. Homogeneous data were pooled using a fixed effects model and heterogeneous data were qualitatively analyzed. MAIN RESULTS Four comparative effectiveness studies including a total of 240 patients were identified. Laparoscopic surgery was associated with a reduced risk of post-operative adverse events (relative risk 0.20, 95% confidence interval 0.06-0.72); no difference was recorded in the risk of post-operative spontaneous abortion (P=0.26) or threatened spontaneous abortion (P=0.13). CONCLUSIONS Laparoscopic surgery could be preferable to laparotomy for suspected adnexal mass during the second trimester of pregnancy.
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Affiliation(s)
- Yi-Xuan Liu
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Yang Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jin-Feng Huang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Li Wang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
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7
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Decidualisation of ovarian endometriomas in pregnancy: a management dilemma. A case report and review of the literature. Arch Gynecol Obstet 2014; 291:961-8. [DOI: 10.1007/s00404-014-3531-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 10/29/2014] [Indexed: 10/24/2022]
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8
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Gasless laparoendoscopic single-site surgery for management of adnexal masses during pregnancy. Eur J Obstet Gynecol Reprod Biol 2014; 180:28-34. [DOI: 10.1016/j.ejogrb.2014.06.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 06/14/2014] [Accepted: 06/19/2014] [Indexed: 11/17/2022]
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9
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Takeda A, Hayashi S, Imoto S, Sugiyama C, Nakamura H. Pregnancy outcomes after emergent laparoscopic surgery for acute adnexal disorders at less than 10 weeks of gestation. J Obstet Gynaecol Res 2014; 40:1281-7. [DOI: 10.1111/jog.12332] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 10/18/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Akihiro Takeda
- Department of Obstetrics and Gynecology; Gifu Prefectural Tajimi Hospital; Tajimi Gifu Japan
| | - Shotaro Hayashi
- Department of Obstetrics and Gynecology; Gifu Prefectural Tajimi Hospital; Tajimi Gifu Japan
| | - Sanae Imoto
- Department of Obstetrics and Gynecology; Gifu Prefectural Tajimi Hospital; Tajimi Gifu Japan
| | - Chisato Sugiyama
- Department of Obstetrics and Gynecology; Gifu Prefectural Tajimi Hospital; Tajimi Gifu Japan
| | - Hiromi Nakamura
- Department of Obstetrics and Gynecology; Gifu Prefectural Tajimi Hospital; Tajimi Gifu Japan
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10
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Nicoll LM, Nezhat C. Laparoscopic management of pelvic pathology during pregnancy. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.4.1.53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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11
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Sesti F, Pietropolli A, Sesti FF, Piccione E. Gasless laparoscopic surgery during pregnancy: evaluation of its role and usefulness. Eur J Obstet Gynecol Reprod Biol 2013; 170:8-12. [PMID: 23746633 DOI: 10.1016/j.ejogrb.2013.04.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 04/10/2013] [Accepted: 04/30/2013] [Indexed: 11/19/2022]
Abstract
The minimally invasive laparoscopic approach in the surgical treatment of diseases during pregnancy has become progressively more accepted and applied. In an attempt to overcome the potential adverse effects of pneumoperitoneum on the fetus, gasless laparoscopic surgery (GLS) has been developed. This article reviews the evidence available for the role and effectiveness of GLS in pregnancy. A computerized literature search was conducted on Medline, Science Citation Index, Current Contents, Embase, and PubMed databases for English language publications from the first report of GLS in pregnancy in 1995 to June 2012. Eleven case reports or retrospective series were identified. A total of 44 pregnant women underwent GLS for various surgical indications. In all cases, the procedures were carried out without complication, and the women were discharged from hospital with a continuing pregnancy. GLS in pregnancy has comparable outcomes to conventional CO2 laparoscopy, but it is associated with some advantages. Hypercarbia and increased intraperitoneal pressure due to CO2 insufflation are avoided. The use of high-pressure continuous suction may prevent the problems that are potentially associated with intra-abdominal smoke generated by electrosurgery, which can increase the risk of fetal exposure to elevated levels of toxic gases. Because this procedure may be performed under regional anesthesia, avoiding general anesthesia, there is a minimal transplacental passage of anesthetic drugs to the fetus. The surgeon must be expert in advanced laparoscopic procedures.
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Affiliation(s)
- Francesco Sesti
- Academic Department of Biomedicine & Prevention and Clinical Department of Surgery, Section of Gynecology, Tor Vergata University Hospital, Rome, Italy.
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Abstract
BACKGROUND The surgical management of ovarian tumors in pregnancy is similar to that of non-pregnant women. The procedures include resection of the tumor (enucleation), removal of an ovary or ovaries (oophorectomy), or surgical excision of the fallopian tube and ovary (salpingo-oophorectomy). The procedure can be done by open surgery (laparotomy) or keyhole surgery (laparoscopy) technique. The benefits of laparoscopic surgery include shorter hospital stay, earlier return to normal activity, and reduced postoperative pain. However, conventional laparoscopic surgery techniques required the infusion of gas carbon dioxide in the peritoneum to distend the abdomen and displace the bowel upward to create the room for surgical manipulation. Serious complications such as abnormally high levels of carbon dioxide in the circulating blood (hypercarbia) and perforation of internal organs have also been reported. These serious complication may be harmful to the fetus. OBJECTIVES To compare the effects of using laparoscopic surgery for benign ovarian tumor during pregnancy on maternal and fetal health and the use of healthcare resources. SEARCH METHODS We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 11 November 2012. SELECTION CRITERIA Randomized controlled trials with reported data that compared outcomes of laparoscopic surgery for benign ovarian tumor in pregnancy to conventional laparotomy technique. DATA COLLECTION AND ANALYSIS Two review authors planned to independently assess trial quality and extract data. MAIN RESULTS The updated search did not identify any randomized controlled trials. AUTHORS' CONCLUSIONS The practice of laparoscopic surgery for benign ovarian tumour during pregnancy is associated with benefits and harms. However, the evidence for the magnitude of these benefits and harms is drawn from case series studies, associated with potential bias. The results and conclusions of these studies must therefore be interpreted with caution.The available case series studies of laparoscopic surgery for benign ovarian tumour during pregnancy provide limited insight into the potential benefits and harms associated with this new surgical technique in pregnancy. Randomized controlled trials are required to provide the most reliable evidence regarding the benefits and harms of laparoscopic surgery for benign ovarian tumour during pregnancy.
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Affiliation(s)
- Suvit Bunyavejchevin
- Department of Obstetrics and Gynecology, Chulalongkorn University Hospital, Bangkok, Thailand.
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Abstract
Epithelial ovarian cancer (EOC) during pregnancy is a rare condition. The diagnosis and treatment strategies are therefore not well defined. The evidence is scarce and limited to small case reports or case series. In this review we describe the safety, utility and limitations of each diagnostic tool and surgical procedure in pregnant women with ovarian cancer. We also discuss the role of chemotherapy for ovarian cancer during pregnancy. Finally, we delineate different strategies of treatment according to the stage of the disease at diagnosis and gestational age. Due to the complexity of the management of EOC during pregnancy, patients should be referred to specialized centers. Gestational age at diagnosis, the initial surgical procedure, disease stage and patient's preferences are the key factors in the decision-making process to establish the best treatment strategy for each individual case.
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14
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Carson MP. The Pregnant Surgical Patient. Perioper Med (Lond) 2012. [DOI: 10.1002/9781118375372.ch18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Biscette S, Yoost J, Hertweck P, Reinstine J. Laparoscopy in pregnancy and the pediatric patient. Obstet Gynecol Clin North Am 2012; 38:757-76. [PMID: 22134021 DOI: 10.1016/j.ogc.2011.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Minimally invasive surgery is now standard of care for many procedures in pediatric gynecology. Laparoscopy has been well documented to produce faster recovery,decreased postoperative pain, and because of smaller incisions, a better cosmetic result. These are important when considering an active pediatric patient. Although a laparoscopic approach to endometriosis, adnexal masses, and ovarian torsion are well supported in the literature in the pediatric patient, more data are needed with regard to SILS in younger patients. Laparoscopy seems to be a better approach to oopheropexy in children undergoing radiation, and in resection of certain mullerian anomalies; however, the numbers are low.Similarly in pregnant patients, laparoscopy provides for shorter recovery times,decrease analgesic use and shorter hospital stays. Concerns about poor fetal outcomes in surgery during pregnancy for non gynecologic problems have been brought to light; however, the evidence indicates that these outcomes can be attributed to the nature of the underlying disease and not the surgical approach. With regard to pneumoperitoneum the effect of CO2 insufflation on fetal physiology and long-term outcomes remains unclear, and will continue to be an issue of controversy until larger studies are published.With both the pediatric and pregnant populations, laparoscopic complications can be diminished when performed by skilled surgeons with strict adherence to good technical principles. The advantages of laparoscopy are great, and this approach should be considered in pediatric and pregnant patients.
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Affiliation(s)
- Shan Biscette
- Department of Obstetrics, Gynecology and Women's Health, Kosair Children's Hospital, Louisville, KY 40207, USA
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16
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Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc 2011; 25:3479-92. [PMID: 21938570 DOI: 10.1007/s00464-011-1927-3] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 08/24/2011] [Indexed: 12/11/2022]
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17
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Robotic surgery for adnexal masses in pregnancy. J Robot Surg 2011; 5:231-3. [PMID: 27637714 DOI: 10.1007/s11701-011-0259-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 02/16/2011] [Indexed: 10/18/2022]
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18
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Vasilev SA, Lentz SE. Intraoperative and Perioperative Considerations in Laparoscopy. Gynecol Oncol 2011. [DOI: 10.1002/9781118003435.ch8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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19
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Wang JJ, Yang F, Gao T, Li L, Xia H, Li HF. Gasless Laparoscopy versus Conventional Laparoscopy in Uterine Myomectomy: A Single-Centre Randomized Trial. J Int Med Res 2011; 39:172-8. [PMID: 21672319 DOI: 10.1177/147323001103900118] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In a single-centre, randomized trial, gasless laparoscopic myomectomy was compared with conventional laparoscopic myomectomy. The study examined feasibility, safety, reliability and post-operative outcomes. Estimated blood loss, duration of surgery, early post-operative outcomes and length of hospital stay were recorded. Compared with conventional laparoscopic myomectomy, gasless laparoscopy resulted in significantly lower intra-operative blood loss (median 100 ml vs 80 ml, respectively) and duration of surgery (median 94 min vs 71 min, respectively). Post-operative abdominal drainage volume was significantly lower after gasless laparoscopy than after conventional laparoscopy (median 100 ml vs 240 ml). There was no significant difference between duration of post-operative fever, post-operative time to flatus or length of hospital stay. Both forms of laparoscopy are suitable for uterine myomectomy, and comparison of these methods showed that gasless laparoscopy had potential advantages over conventional laparoscopy.
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Affiliation(s)
- J-J Wang
- Department of Gynaecology and Obstetrics, Tongji Hospital, Shanghai, China
| | - F Yang
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - T Gao
- Department of Gynaecology and Obstetrics, Tongji Hospital, Shanghai, China
| | - L Li
- Department of Gynaecology and Obstetrics, Tongji Hospital, Shanghai, China
| | - H Xia
- Department of Gynaecology and Obstetrics, Tongji Hospital, Shanghai, China
| | - H-F Li
- Department of Gynaecology and Obstetrics, Tongji Hospital, Shanghai, China
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The Pregnant Surgical Patient. Perioper Med (Lond) 2011. [DOI: 10.1007/978-0-85729-498-2_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Takeda A, Imoto S, Mori M, Nakano T, Nakamura H. Early experience with isobaric laparoendoscopic single-site surgery using a wound retractor for the management of ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol 2010; 154:209-14. [PMID: 21056526 DOI: 10.1016/j.ejogrb.2010.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 08/17/2010] [Accepted: 10/07/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To report our initial experience with isobaric (gasless) transumbilical laparoendoscopic single-site (LESS) surgery using a wound retractor for the management of ectopic pregnancy. STUDY DESIGN Twelve consecutive cases of ectopic pregnancy were managed by isobaric LESS surgery with the subcutaneous abdominal wall-lift method. In each case, a wound retractor was used as a transumbilical working port with insertion into the peritoneal cavity through a 2.5-cm vertical umbilical incision. Subsequent surgical procedures were performed with multiple conventional laparoscopic instruments through single umbilical port. RESULTS All cases of ectopic pregnancy were successfully managed by isobaric LESS surgery. Procedures included salpingectomy in eight cases of ampullary pregnancy and two cases of isthmic pregnancy, salpingectomy and local methotrexate injection in one case of isthmic pregnancy, and salpingo-oophorectomy for one case of ovarian pregnancy. Neither extraumbilical incisions nor conversion to laparotomy was required. In a case of ruptured ampullary pregnancy with massive hemoperitoneum, intraoperative autologous blood salvage and donation avoided the need for the transfusion of bank blood. Although postsurgical umbilical seroma was noted in one case and systemic methotrexate administration was required for persistent ectopic pregnancy in one case of isthmic pregnancy respectively, there were no major surgical complications in this series. The technique yielded excellent cosmetic results with minimum postoperative scar concealed within umbilicus. Retrospective comparison of surgical parameters including surgical duration, estimated blood loss, frequency of postoperative analgesic use, time of bowel recanalization, postoperative inflammatory response and postoperative hospital stay did not show any significant differences between isobaric LESS surgery group and conventional isobaric multiport laparoscopic surgery group. CONCLUSIONS Based on the satisfactory outcome achieved in these initial 12 cases of ectopic pregnancy treated by isobaric LESS surgery, the wound retraction system combined with the subcutaneous abdominal wall-lift method appears to contribute favorably to LESS surgery for the management of ectopic pregnancy because the device permits free circumferential access and retraction during procedures without the closed condition required during pneumoperitoneum.
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Affiliation(s)
- Akihiro Takeda
- Department of Obstetrics & Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan.
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Fanfani F, Rossitto C, Fagotti A, Rosati P, Gallotta V, Scambia G. Laparoscopic Myomectomy at 25 Weeks of Pregnancy: Case Report. J Minim Invasive Gynecol 2010; 17:91-3. [DOI: 10.1016/j.jmig.2009.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 08/12/2009] [Accepted: 08/20/2009] [Indexed: 10/20/2022]
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23
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The management of ovarian pathology in pregnancy. Best Pract Res Clin Obstet Gynaecol 2009; 23:539-48. [DOI: 10.1016/j.bpobgyn.2009.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 01/05/2009] [Indexed: 11/24/2022]
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Kitade M, Takeuchi H, Kumakiri J, Shimanuki H, Kikuchi I, Takeda S. Instruments and Techniques: Two-Puncture Extracorporeal Method—a New Technique for Laparoscopic Management of Ovarian Tumors Detected During Pregnancy. J Gynecol Surg 2008. [DOI: 10.1089/gyn.2008.b-02301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mari Kitade
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takeuchi
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan
| | - Jun Kumakiri
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroto Shimanuki
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan
| | - Iwaho Kikuchi
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan
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Jackson H, Granger S, Price R, Rollins M, Earle D, Richardson W, Fanelli R. Diagnosis and laparoscopic treatment of surgical diseases during pregnancy: an evidence-based review. Surg Endosc 2008; 22:1917-27. [PMID: 18553201 DOI: 10.1007/s00464-008-9989-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Accepted: 05/05/2008] [Indexed: 12/16/2022]
Abstract
Treatment of surgical disease in the gravid patient requires a unique and careful approach where safety of the mother and fetus are both considered. Approaches to diagnosis and therapy of surgical disease in the gravid patient are increasingly clarified and defined in the literature. Laparoscopy, once described as contraindicated in pregnancy, has been steadily accepted and applied as data supporting its safety and use have accumulated. An extensive review of the literature was performed to define the use of laparoscopy in pregnancy. Diagnoses for independent surgical diseases as well as imaging modalities and techniques during pregnancy are reviewed. Preoperative, intraoperative, and postoperative management of the pregnant patient are described and evaluated with focus on use of laparoscopy. Literature supporting safety and efficacy of laparoscopy in cholecystectomy, appendectomy, solid organ resection, and oophorectomy in the gravid patient is outlined. Based on level of evidence, this review includes recommendations specific to surgical approach, trimester of pregnancy, patient positioning, port placement, insufflation pressure, monitoring, venous thromboembolic prophylaxis, obstetric consultation, and use of tocolytics in the pregnant patient.
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Affiliation(s)
- Heidi Jackson
- Department of Surgery, University of Utah Medical Center, Salt Lake City, UT, USA
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Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc 2008; 22:849-61. [DOI: 10.1007/s00464-008-9758-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2007] [Accepted: 01/08/2008] [Indexed: 01/06/2023]
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Gasless Laparoscopic Surgery for Ovarian Cyst in a Second Trimester Pregnant Patient With a Ventricular Septal Defect. Surg Laparosc Endosc Percutan Tech 2007; 17:565-7. [DOI: 10.1097/sle.0b013e318120028c] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND The surgical management of ovarian tumors in pregnancy is similar to that of non-pregnant women. The procedures include resection of the tumor (enucleation), removal of an ovary or ovaries (oophorectomy), or surgical excision of the fallopian tube and ovary (salpingo-oophorectomy). The procedure can be done by open surgery (laparotomy) or keyhole surgery (laparoscopy) technique. The benefits of laparoscopic surgery include shorter hospital stay, earlier return to normal activity, and reduced postoperative pain. However, conventional laparoscopic surgery techniques required the infusion of gas carbon dioxide in the peritoneum to distend the abdomen and displace the bowel upward to create the room for surgical manipulation. Serious complications such as abnormally high levels of carbon dioxide in the circulating blood (hypercarbia) and perforation of internal organs have also been reported. These serious complication may be harmful to the fetus. OBJECTIVES To compare the effects of using laparoscopic surgery for benign ovarian tumor during pregnancy on maternal and fetal health and the use of healthcare resources. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 June 2006). SELECTION CRITERIA Randomized controlled trials with reported data that compared outcomes of laparoscopic surgery for benign ovarian tumor in pregnancy to conventional laparotomy technique. DATA COLLECTION AND ANALYSIS Two review authors planned to independently assess trial quality and extract data. MAIN RESULTS There were no randomized controlled trials identified. AUTHORS' CONCLUSIONS The practice of laparoscopic surgery for benign ovarian tumour during pregnancy is associated with benefits and harms. However, the evidence for the magnitude of these benefits and harms is drawn from case series studies, associated with potential bias. The results and conclusions of these studies must therefore be interpreted with caution. The available case series studies of laparoscopic surgery for benign ovarian tumour during pregnancy provide limited insight into the potential benefits and harms associated with this new surgical technique in pregnancy. Randomized controlled trials are required to provide the most reliable evidence regarding the benefits and harms of laparoscopic surgery for benign ovarian tumour during pregnancy.
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Affiliation(s)
- S Bunyavejchevin
- Chulalongkorn University Hospital, Department of Obstetrics and Gynecology, Bangkok, Thailand.
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Purnichescu V, Cheret-Benoist A, Von Theobald P, Mayaud A, Herlicoviez M, Dreyfus M. Prise en charge cœlioscopique des masses latéro-utérines pendant la grossesse. ACTA ACUST UNITED AC 2006; 35:388-95. [PMID: 16940907 DOI: 10.1016/s0368-2315(06)76410-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the feasibility, safety and limiting factors of laparoscopic management of pelvic mass in pregnancy. MATERIAL and methods. During a 10-year period, 21 laparoscopic procedures were performed in patients with pelvic masses in pregnancy after exclusion of appendicitis and ectopic pregnancy. Laparoscopic surgery was done during the first trimester of pregnancy in 8 cases, the second trimester in 12 cases and the third trimester in one case. All the procedures were performed with general anesthesia and the laparoscopic cystectomies were performed with the intraperitoneal technique. RESULTS The indications were: persistent or sonographically abnormal ovarian cyst (12 cases), torsion of ovarian cyst (5 cases), and symptomatic pelvic mass (4 cases: 2 painful cysts and 2 infarction of fibroma). One borderline tumor were discovered. The laparoscopic procedure could not be performed in two cases due to difficulty of access to the lesion. No patient encountered complications during the intra- and post-operative periods. The mean hospital stay was 4.5 days. The outcome of the pregnancy was normal in all cases. CONCLUSION Laparoscopic management of pelvic masses in pregnancy by an experienced team, is a safe and effective procedure.
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Affiliation(s)
- V Purnichescu
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Caen, avenue Georges-Clemenceau, 14033 Caen Cedex
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Abstract
PURPOSE OF REVIEW 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. RECENT FINDINGS 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. SUMMARY 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.
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Affiliation(s)
- Nollag O'Rourke
- Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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Lenglet Y, Roman H, Rabishong B, Bourdel N, Bonnin M, Bolandard F, Duband P, Pouly JL, Mage G, Canis M. [Laparoscopic management of ovarian cysts during pregnancy]. ACTA ACUST UNITED AC 2006; 34:101-6. [PMID: 16442326 DOI: 10.1016/j.gyobfe.2005.11.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2005] [Accepted: 11/21/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the results of laparoscopic surgery in the management of ovarian cysts in pregnant patients. PATIENTS AND METHODS Retrospective study including 26 pregnant patients who underwent the laparoscopic management of ovarian cysts. The indications for surgery were persistent adnexal mass, abnormal ovarian cysts revealed by ultrasound examination, suspicion of cyst complications. The technique used, the immediate postoperative results and obstetrical outcomes were studied. RESULTS Twelve patients were operated during the first trimester of pregnancy, 13 in the second, and one in the third trimester. A 12 mmHg CO2 pneumoperitoneum was created, using a Veress needle in 22 cases, and an open technique in 4 cases. Trocar sites were decided according to the uterine size and to the cyst situation. A cystectomy was performed in 11 cases, an adnexectomy in 7 cases, an oophorectomy in one case, a cyst aspiration with a biopsy of the cyst wall in 6 cases and an ovarian torsion removal in one case. A conversion to laparotomy was necessary in 3 cases. There were no immediate postoperative complications and obstetrical outcomes were good in all cases. DISCUSSION AND CONCLUSION In pregnant patients, laparoscopic management of adnexal masses appears to be safe for both mother and child.
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Affiliation(s)
- Y Lenglet
- Service de Gynécologie, Obstétrique et Médecine de la Reproduction, Polyclinique Hôtel-Dieu, CHU de Clermont-Ferrand, 11, boulevard Léon-Malfreyt, 63058 Clermont-Ferrand cedex 01, France.
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Cohen-Kerem R, Railton C, Oren D, Lishner M, Koren G. Pregnancy outcome following non-obstetric surgical intervention. Am J Surg 2005; 190:467-73. [PMID: 16105538 DOI: 10.1016/j.amjsurg.2005.03.033] [Citation(s) in RCA: 192] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2004] [Revised: 03/15/2005] [Accepted: 03/15/2005] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the effects of non-obstetric surgical procedures on maternal and fetal outcome. METHODS A systematic review of all English language literature. RESULTS Fifty-four papers met the inclusion criteria. The overall number of patients reported was 12,452. Reported maternal death was rare at .006%. The miscarriage rate was 5.8%; however, this number is difficult to interpret since matched controls were not available. The rate of elective termination of pregnancy following non-obstetric surgery was 1.3%. The rate of premature labor induced by non-obstetric surgical intervention was 3.5% and this was noted specifically following appendectomy versus other types of interventions (P<.001). A total of 2.5% of pregnancies resulted in fetal loss. The prematurity rate was 8.2%. The rate of major birth defects among women who underwent non-obstetric surgical intervention in the first trimester was 3.9%. Sub-analysis of papers reporting on appendectomy during pregnancy revealed a high rate (4.6%) of surgery-induced labor. Fetal loss associated with appendectomy was 2.6%; however, this rate was increased when peritonitis was present (10.9%). CONCLUSIONS Modern surgical and anesthesia techniques appear to diminish the rate of maternal death. Surgery in the first trimester does not appear to increase major birth defects and should not be delayed when indicated. Acute appendicitis with peritonitis is associated with higher risk to the mother and fetus.
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Affiliation(s)
- Raanan Cohen-Kerem
- Motherisk Program, Division of Clinical Pharmacology and Toxicology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8
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Laparoscopy versus laparotomy for the treatment of ovarian cysts in pregnancy: should we change our conventional way of practice? ACTA ACUST UNITED AC 2005. [DOI: 10.1007/s10397-005-0108-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Akira S, Abe T, Igarashi K, Nishi Y, Kurose K, Watanabe M, Takeshita T. Gasless Laparoscopic Surgery Using a New Intra-abdominal Fan Retractor System: An Experience of 500 Cases. J NIPPON MED SCH 2005; 72:213-6. [PMID: 16113491 DOI: 10.1272/jnms.72.213] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AIM The aim of this study is to report the feasibility of a newly developed intra-abdominal fan retractor system for use in gynecologic laparoscopic surgery. METHODS Five hundred women undergoing gasless laparoscopic surgery using the abdominal wall lifting device were included in the study. The intraoperative and postoperative courses, and complications were examined. RESULTS The intra-abdominal retractor system provided adequate exposure in all cases, except for one patient with morbid obesity. Neither the presence of the intra-abdominal retractor blades nor the mechanical arm interfered with the placement of instruments during surgery. No complications related to the use of gasless laparoscopy were encountered in this study period. CONCLUSION The new intra-abdominal fan retractor system is feasible in gynecologic laparoscopic surgery.
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Affiliation(s)
- Shigeo Akira
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan.
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Knudsen UB, Tabor A, Mosgaard B, Andersen ES, Kjer JJ, Hahn-Pedersen S, Toftager-Larsen K, Mogensen O. Management of ovarian cysts. Acta Obstet Gynecol Scand 2004; 83:1012-21. [PMID: 15488114 DOI: 10.1111/j.0001-6349.2004.00607.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The treatment of an ovarian cyst relies on its nature, and accurate preoperative discrimination of benign and malignant cysts is therefore of crucial importance. This study was undertaken to review the literature concerning the preoperative diagnosis and treatment of ovarian cysts. METHODS Articles concerning ovarian cysts from a medline literature search during the period 1985-2003 were included in addition to articles found as references in the initial publications. RESULTS Different methods for discriminating between benign and malignant ovarian cysts are discussed. The diagnosis and the treatment are assessed in relation to age, menopausal status, pregnancy, and whether the cyst is presumed to be benign or malignant. In general, expectant management is the choice in premenopausal and pregnant women with non-suspicious cysts and normal levels of CA-125. In postmenopausal women, unilocular, anechoic cysts less than 5 cm in diameter together with a normal CA-125 may be followed up. Operation is recommended in women with cysts larger than 5 cm and/or elevated levels of CA-125. Women with symptoms should be operated regardless of age, menopausal status, or ultrasound findings. CONCLUSIONS The preoperative discrimination between benign and malignant ovarian cysts is a challenge. Multimodal methods improve the results of single modalities, but we still need improved preoperative diagnostic tools. Furthermore, these methods should be validated in consecutive patient populations large enough to give a reliable estimate of the method's sensitivity and specificity.
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Affiliation(s)
- Ulla Breth Knudsen
- Department of Obstetrics and Gynecology, Odense University Hospital, Denmark.
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Yuen PM, Ng PS, Leung PL, Rogers MS. Outcome in laparoscopic management of persistent adnexal mass during the second trimester of pregnancy. Surg Endosc 2004; 18:1354-7. [PMID: 15164277 DOI: 10.1007/s00464-003-8283-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2003] [Accepted: 02/19/2004] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study evaluated the safety of laparoscopic management for persistent adnexal mass in the second trimester of pregnancy. METHODS Between April 1994 and March 2003, 67 consecutive women underwent laparoscopic removal of adnexal masses that had persisted into the second trimester of pregnancy in an academic tertiary referral center. Operative complications, pregnancy, and labor outcomes were evaluated. RESULTS The median gestation was 10.5 weeks (range, 5-25 weeks) at diagnosis and 16 weeks (range, 12-25 weeks) at the time of operation. Only two women required for conversion to laparotomy. Cystectomy was performed for 55 women, oophorectomy for 9 women and fenestration in 3 women. There were no intraoperative complications or major postoperative complications. No women were given tocolytic therapy, and none experienced uterine contractions. There was one spontaneous abortion 6 weeks after the operation, and one patent was lost to follow up. Of the remaining 65 women, the median gestation at delivery was 39 weeks (range, 33-42 weeks), and the median birthweight was 3,160 g (range, 2,220-4,200 g). CONCLUSIONS Laparosocpic surgery for persistent adnexal masses in the second trimester of pregnancy is safe when performed by experienced surgeons.
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Affiliation(s)
- P M Yuen
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Chinese University of Hong Kong, Shantin, N.T., Hong Kong SAR.
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Murakami T, Noda T, Okamura C, Terada Y, Morito Y, Okamura K. Cul-de-sac packing with a metreurynter in gasless laparoscopic cystectomy during pregnancy. ACTA ACUST UNITED AC 2004; 10:421-3. [PMID: 14567828 DOI: 10.1016/s1074-3804(05)60278-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Gasless laparoscopic cystectomy was performed for a woman in the fifteenth week of pregnancy. An ovarian cyst that had been sinking behind the uterus appeared spontaneously after ballooning the metreurynter in the pouch of Douglas. This allowed extraperitoneal cystectomy, and the patient's subsequent antenatal course was uneventful. Cul-de-sac packing with a metreurynter permits gentle and atraumatic manipulation against the pregnant uterus.
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Affiliation(s)
- Takashi Murakami
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Japan
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Mathevet P, Nessah K, Dargent D, Mellier G. Laparoscopic management of adnexal masses in pregnancy: a case series. Eur J Obstet Gynecol Reprod Biol 2003; 108:217-22. [PMID: 12781415 DOI: 10.1016/s0301-2115(02)00374-3] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the feasibility, safety, limiting factors, and advantages of laparoscopic management of adnexal masses in pregnancy. STUDY DESIGN During a 12-year period, 48 laparoscopic procedures were performed in 47 patients with adnexal masses in pregnancy. Laparoscopic surgery was done during the first trimester of pregnancy in 17 cases, the second trimester in 27 cases and the third trimester in four cases. All the procedures were performed with general anesthesia and curarization. The laparoscopic cystectomies were performed either with the intra-peritoneal or the trans-peritoneal technique. RESULTS The indications were: persistant or sonographically abnormal ovarian cyst (36 cases), torsion or rupture of ovarian cyst (8 cases), and symptomatic pelvic mass (3 cases). Two borderline tumors were discovered. The laproscopic procedure could not be performed in two cases due to dense adhesions and difficulty of hemostasis. No patient encountered complications during the intra- and post-operative periods. The mean hospital stay was 3.8 days. The outcome of the pregnancy was normal in all cases except one fetal loss 4 days after the laparoscopy. CONCLUSION Laparoscopic management of adnexal masses in pregnancy by an experienced team, is a safe and effective procedure that allows, compared to the traditional surgery, a shorter hospital stay, a reduced rate of post-operative complications and a decreased maternal and fetal morbidity.
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Affiliation(s)
- Patrice Mathevet
- Department of Obstetrics and Gynecology, Pavillon L, Hopital E. Herriot, Place d'Arsonval, 69437 Cedex O3, Lyon, France.
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Oelsner G, Stockheim D, Soriano D, Goldenberg M, Seidman DS, Cohen SB, Admon D, Novikov I, Maschiach S, Carp HJA, Anderman S, Ben-Ami M, Ben-Arie A, Hagay Z, Bustan M, Shalev E, Carp H, Gemer O, Golan A, Holzinger M, Beyth Y, Horowitz A, Hamani Y, Keis M, Lavie O, Luxman D, Oelsner G, Stockheim D, Rojansky N, Taichner G, Yafe C, Zohar S, Bilanca B. Pregnancy outcome after laparoscopy or laparotomy in pregnancy. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2003; 10:200-4. [PMID: 12732772 DOI: 10.1016/s1074-3804(05)60299-x] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVE To assess obstetric performance and fetal outcomes after laparoscopy or laparotomy performed during pregnancy. DESIGN Nationwide, multicenter, retrospective chart review (Canadian Task Force classification II-2). SETTING Seventeen hospitals throughout Israel: 12 university or university-affiliated hospitals and 5 general hospitals. PATIENTS Three hundred eighty-nine pregnant women. INTERVENTION Laparoscopy or laparotomy for various indications. MEASUREMENTS AND MAIN RESULTS Of 192 laparoscopies performed, 141 were during the first, 46 during the second, and 5 during the third trimester; respective figures for 197 laparotomies were 63, 110, and 24. No intraoperative complications were reported for either procedure. Six and 25 women had complications after laparoscopy and laparotomy, respectively. There was no significant difference in abortion rates between groups. Mean gestational age at delivery and mean birthweight were comparable between groups. No significant difference was found in frequency of fetal anomalies between groups or when compared with the Israel register of anomalies. CONCLUSION Operative laparoscopy seems to be as safe as laparotomy in pregnancy.
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Affiliation(s)
- Gabriel Oelsner
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
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40
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Affiliation(s)
- Mazen Bisharah
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
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41
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Abstract
PURPOSE OF REVIEW 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. RECENT FINDINGS 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. SUMMARY 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.
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Affiliation(s)
- Haya Al-Fozan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
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Römer T, Bojahr B, Schwesinger G. Treatment of a torqued hematosalpinx in the thirteenth week of pregnancy using gasless laparoscopy. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2002; 9:89-92. [PMID: 11821614 DOI: 10.1016/s1074-3804(05)60112-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Laparotomy and carbon dioxide laparoscopy are relatively traumatic and high-risk operations for patients. They may have negative effects on pregnancy, especially in advanced pregnancy. Gasless laparoscopy was performed on torqued hematosalpinx in a woman in the thirteenth week of pregnancy. After salpingectomy, the pregnancy proceeded normally.
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Affiliation(s)
- T Römer
- Department of Obstetrics and Gynaecology, University of Greifswald, Germany
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Akira S. [Endoscopic surgery in obstetric and gynecologic fields]. J NIPPON MED SCH 2001; 68:524-9. [PMID: 11744934 DOI: 10.1272/jnms.68.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- S Akira
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan.
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Schmidt T, Nawroth F, Foth D, Rein DT, Römer T, Mallmann P. Gasless laparoscopy as an option for conservative therapy of adnexal pedical torsion with twin pregnancy. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2001; 8:621-2. [PMID: 11677354 DOI: 10.1016/s1074-3804(13)60008-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abu-Musa A, Nassar A, Usta I, Khalil A, Hussein M. Laparoscopic unwinding and cystectomy of twisted dermoid cyst during second trimester of pregnancy. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2001; 8:456-60. [PMID: 11509794 DOI: 10.1016/s1074-3804(05)60351-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A woman in the sixteenth week of pregnancy experienced acute abdominal pain, and magnetic resonance imaging suggested a dermoid cyst. Laparoscopic unwinding and cystectomy of the twisted cyst was performed successfully.
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Affiliation(s)
- A Abu-Musa
- Department of Obstetrics and Gynecology, P.O. Box 113-6044-6A, American University of Beirut Medical Center, Beirut, Lebanon
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46
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Edwards RK, Ripley DL, Davis JD, Bennett BB, Simms-Cendan JS, Cendan JC, Stone IK. Surgery in the pregnant patient. Curr Probl Surg 2001; 38:213-90. [PMID: 11296493 DOI: 10.1067/msg.2001.112768] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- R K Edwards
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida, USA
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Shay DC, Bhavani-Shankar K, Datta S. Laparoscopic surgery during pregnancy. ANESTHESIOLOGY CLINICS OF NORTH AMERICA 2001; 19:57-67. [PMID: 11244920 DOI: 10.1016/s0889-8537(05)70211-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Important factors in laparoscopic surgery during pregnancy are listed here: There is a risk of aspiration because of a hormonally induced decrease in lower esophageal sphincter tone and mechanical effects of a gravid uterus. Supine hypotensive syndrome because of aortocaval compression can be a major problem. Pneumoperitoneum during pregnancy results in more pronounced restrictive lung physiology. Avoid hypoxemia, hypotension, acidosis, hypoventilation, and hyperventilation. No anesthetic drugs have been proven to be teratogenic in humans. Surgery during pregnancy is associated with the delivery of low birth-weight, growth-restricted babies. Standard noninvasive monitoring could be sufficient for healthy parturients undergoing laparoscopic surgery. Fetal heart rate and uterine activity should be monitored pre- and postoperatively. Laparoscopic surgery during pregnancy is safe, has multiple advantages over open techniques, can be performed during all gestational ages, and does not require invasive or continuous fetal and uterine monitoring for routine cases; however, the anesthesiologist must be aware of the physiologic changes associated with pregnancy and the effects of positioning, and the consequences of CO2 pneumoperitoneum on the parturient and the fetus. Although no special monitoring is required in healthy parturients, each case must be assessed carefully, and invasive monitoring could be required in those patients with significant cardiovascular or pulmonary disease. Fetal heart rate should be assessed preoperatively and postoperatively. Surveillance with an external tocodynamometer should be instituted immediately preoperatively and postoperatively and tocolytic agents instituted if documented or perceived uterine activity is detected.
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Affiliation(s)
- D C Shay
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Abstract
In the last decade, operative laparoscopic procedures are performed increasingly in both gynecology and general surgery. The major advantages of this newer minimally invasive approach are: decreased postoperative morbidity, less pain and decreased need for analgesics, early normal bowel function, shorter hospital stay, and early return to normal activity. With the advancement of laparoscopic surgery, its use during pregnancy is becoming more widely accepted. The most commonly reported laparoscopic operation during pregnancy is laparoscopic cholecystectomy (LC). Other laparoscopic procedures commonly performed during pregnancy include: management of adnexal mass, ovarian torsion, ovarian cystectomy, appendectomy, and ectopic pregnancy. The possible drawbacks of laparoscopic surgery during pregnancy may include injury of the pregnant uterus and the technical difficulty of laparoscopic surgery due to the growing mass of the gravid uterus. Also, the potential risk of decreased uterine blood flow secondary to the increase in intraabdominal pressure and the possible risk of carbon dioxide absorption to both the mother and fetus should be taken into account. To date, data on laparoscopic surgery during pregnancy are insufficient to draw conclusions on its safety and exact complication rate. This is due to the few cases reported and the lack of prospective studies. Furthermore, there is a common tendency to underreport unsuccessful cases. Finally, most reports in the literature come from centers and surgeons with special interest, experience, and skills in laparoscopy, and their results may not reflect the real complication rates. We have reviewed the pertinent English literature from the last decade. The cumulative experience suggests that laparoscopic surgery may be performed safely during pregnancy, although more studies are needed to establish its exact rate of adverse events.
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Affiliation(s)
- M Fatum
- Department of Obstetrics & Gynecology, Hadassah Ein-Kerem Medical Center, The Hebrew University Medical School, Jerusalem, Israel
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Argenta PA, Nezhat F. Approaching the adnexal mass in the new millennium. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2000; 7:455-71. [PMID: 11044496 DOI: 10.1016/s1074-3804(05)60358-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Adnexal masses are common dilemmas faced by practicing gynecologists. They affect women from before birth throughout life, yet considerable disagreement exists regarding their optimal management. Traditional management focused on avoiding undertreatment of a potentially malignant process. Advances in detection, diagnosis, and minimally invasive management make it necessary to review this practice to avoid unnecessary morbidity and mortality. The literature emphasizes a minimally invasive approach to the treatment of benign lesions without sacrificing the principles of oncologic surgery.
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Affiliation(s)
- P A Argenta
- 1 Gustave L. Levy Place, Box 1173, New York, NY 10029, USA
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