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Tsutsui K, Miki A, Wakita T, Horibe Y, Tani M, Kakuta Y, Tsutahara K, Takao T. A case of robot-assisted laparoscopic partial nephrectomy during pregnancy. IJU Case Rep 2023; 6:458-460. [PMID: 37928313 PMCID: PMC10622195 DOI: 10.1002/iju5.12647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/16/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Malignancy during pregnancy requires consideration of both the mother and fetus. We report a patient with renal cell carcinoma during pregnancy who was treated with robot-assisted partial nephrectomy. Case presentation The patient was incidentally found to have a renal mass on abdominal ultrasonography. Definitive diagnosis of cT1aN0M0 RCC was made by enhanced computed tomography. Subsequently, pregnancy was discovered. RAPN was performed without complications. Pathologic examination revealed clear cell RCC. There were no postoperative complications, and the baby was born safely. Conclusion RAPN can be safe and effective even during pregnancy. Every pregnant patient requires individualized treatment involving the timing of surgery, the procedure used, and management based on the condition of the mother and fetus, tumor stage, and the experience of the surgical team.
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Affiliation(s)
- Kenji Tsutsui
- Department of UrologyOsaka General Medical CenterOsakaJapan
| | - Airi Miki
- Department of UrologyOsaka General Medical CenterOsakaJapan
| | - Teppei Wakita
- Department of UrologyOsaka General Medical CenterOsakaJapan
| | - Yuki Horibe
- Department of UrologyOsaka General Medical CenterOsakaJapan
| | - Masaru Tani
- Department of UrologyOsaka General Medical CenterOsakaJapan
| | - Yoichi Kakuta
- Department of UrologyOsaka General Medical CenterOsakaJapan
| | | | - Tetsuya Takao
- Department of UrologyOsaka General Medical CenterOsakaJapan
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2
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Bradford V, Gaiser R. Preservation of Fetal Viability During Noncardiac Surgery. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00030-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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3
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Pearl JP, Price RR, Tonkin AE, Richardson WS, Stefanidis D. SAGES guidelines for the use of laparoscopy during pregnancy. Surg Endosc 2017. [DOI: 10.1007/s00464-017-5637-3] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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4
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Could laparoscopic appendectomy in pregnant women affect obstetric outcomes? A multicenter study. Int J Colorectal Dis 2016; 31:1475-81. [PMID: 27072934 DOI: 10.1007/s00384-016-2584-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to compare the perioperative and obstetric outcomes of pregnant women between laparoscopic surgery and open surgery and to evaluate the predictive factors for overall obstetric outcomes. METHODS We retrospectively reviewed the medical records of pregnant women who underwent appendectomy between January 2008 and June 2015 at six hospitals affiliated to Hallym University. RESULTS Eighty patients were evaluated. Twenty-four underwent laparoscopic appendectomy (LA) and 56 underwent open appendectomy (OA). There were no significant differences in the patients' characteristics and gestational age at surgery between the two groups. Operation time, time to flatus, and time to soft food intake were similar in both groups. The length of stay was shorter in the LA group than in the OA group (5.1 vs 8.1 days, P = 0.044). Gestational age at delivery, birth weight, and delivery type were similar in both groups. There was no significant difference in overall obstetric poor outcome (20.8 vs 14.3 %, P = 0.516), including preterm delivery (8.3 vs 7.1 %, P = 1.000) and fetal loss (12.5 vs 7.1 %, P = 0.350). Multivariable analysis revealed that fever >38 °C (P = 0.022) and maternal age (P = 0.044) were independent predictors for the overall poor outcomes. CONCLUSIONS LA was associated with shorter length of stay compared with OA, but perioperative and obstetric outcomes were similar with both procedures. LA can be safely performed in pregnant women in any trimester.
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Shaw CJ, Civale J, Botting KJ, Niu Y, Ter Haar G, Rivens I, Giussani DA, Lees CC. Noninvasive high-intensity focused ultrasound treatment of twin-twin transfusion syndrome: A preliminary in vivo study. Sci Transl Med 2016; 8:347ra95. [PMID: 27412787 DOI: 10.1126/scitranslmed.aaf2135] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 06/13/2016] [Indexed: 02/11/2024]
Abstract
We investigated the efficacy, maternofetal responses, and safety of using high-intensity focused ultrasound (HIFU) for noninvasive occlusion of placental vasculature compared to sham treatment in anesthetized pregnant sheep. This technique for noninvasive occlusion of placental vasculature may be translatable to the treatment of conditions arising from abnormal placental vasculature, such as twin-twin transfusion syndrome (TTTS). Eleven pregnant sheep were instrumented with maternal and fetal arterial catheters and time-transit flow probes to monitor cardiovascular, acid-base, and metabolic status, and then exposed to HIFU (n = 5) or sham (n = 6) ablation of placental vasculature through the exposed uterine surface. Placental vascular flow was occluded in 28 of 30 targets, and histological examination confirmed occlusion in 24 of 30 targets. In both HIFU and sham exposures, uterine contact reduced maternal uterine artery flow, but delivery of oxygen and glucose to the fetal brain remained normal. HIFU can consistently occlude in vivo placental vessels and ablate blood flow in a pregnant sheep model. Cardiovascular and metabolic fetal responses suggest that the technique is safe in the short term and potentially translatable to human pregnancy.
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Affiliation(s)
- Caroline J Shaw
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK. Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0HS, UK
| | - John Civale
- Joint Department of Physics, Institute of Cancer Research, Sutton, London SM2 5NG, UK
| | - Kimberley J Botting
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK
| | - Youguo Niu
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK
| | - Gail Ter Haar
- Joint Department of Physics, Institute of Cancer Research, Sutton, London SM2 5NG, UK
| | - Ian Rivens
- Joint Department of Physics, Institute of Cancer Research, Sutton, London SM2 5NG, UK
| | - Dino A Giussani
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK
| | - Christoph C Lees
- Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0HS, UK. Department of Obstetrics and Gynaecology, University Hospitals Leuven, 3000 Leuven, Belgium.
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6
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Gatson BJ, Pablo L, Plummer CE, Granone TD. Effects of premedication with sustained-release buprenorphine hydrochloride and anesthetic induction with ketamine hydrochloride or propofol in combination with diazepam on intraocular pressure in healthy sheep. Am J Vet Res 2015; 76:771-9. [DOI: 10.2460/ajvr.76.9.771] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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7
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Rajmohan N, Prakasam H, Simy J. Laparoscopic surgeries during second and third trimesters of pregnancy in a tertiary care centre in South India: Anaesthetic implications and long-term effects on children. Indian J Anaesth 2014; 57:612-5. [PMID: 24403626 PMCID: PMC3883401 DOI: 10.4103/0019-5049.123339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Nisha Rajmohan
- Department of Anaesthesiology, PVS Memorial Hospital, Kaloor, Kochi, Kerala, India
| | - Hassy Prakasam
- Department of Anaesthesiology, PVS Memorial Hospital, Kaloor, Kochi, Kerala, India
| | - J Simy
- Department of Anaesthesiology, PVS Memorial Hospital, Kaloor, Kochi, Kerala, India
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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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9
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Candiani M, Maddalena S, Barbieri M, Izzo S, Alberico D, Ronzoni S. Adnexal Masses in Pregnancy: Fetomaternal Blood Flow Indices During Laparoscopic Surgery. J Minim Invasive Gynecol 2012; 19:443-7. [DOI: 10.1016/j.jmig.2012.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 03/02/2012] [Accepted: 03/08/2012] [Indexed: 11/25/2022]
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10
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Reitman E, Flood P. Anaesthetic considerations for non-obstetric surgery during pregnancy. Br J Anaesth 2012; 107 Suppl 1:i72-8. [PMID: 22156272 DOI: 10.1093/bja/aer343] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Surgery during pregnancy is complicated by the need to balance the requirements of two patients. Under usual circumstances, surgery is only conducted during pregnancy when it is absolutely necessary for the wellbeing of the mother, fetus, or both. Even so, the outcome is generally favourable for both the mother and the fetus. All general anaesthetic drugs cross the placenta and there is no optimal general anaesthetic technique. Neither is there convincing evidence that any particular anaesthetic drug is toxic in humans. There is weak evidence that nitrous oxide should be avoided in early pregnancy due to a potential association with pregnancy loss with high exposure. There is evidence in animal models that many general anaesthetic techniques cause inappropriate neuronal apoptosis and behavioural deficits in later life. It is not known whether these considerations affect the human fetus but studies are underway. Given the general considerations of avoiding fetal exposure to unnecessary medication and potential protection of the maternal airway, regional anaesthesia is usually preferred in pregnancy when it is practical for the medical and surgical condition. When surgery is indicated during pregnancy maintenance of maternal oxygenation, perfusion and homeostasis with the least extensive anaesthetic that is practical will assure the best outcome for the fetus.
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Affiliation(s)
- E Reitman
- Department of Anesthesiology, Columbia University, New York, NY 10032, USA
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11
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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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Abstract
Currently there is no evidence for prophylactic cholecystectomy to prevent gallstone formation (grade B). Cholecystectomy cannot be recommended for any group of patients having asymptomatic gallstones except in those undergoing major upper abdominal surgery for other pathologies (grade B). Laparoscopic cholecystectomy is the preferred treatment for all patient groups with symptomatic gallstones (grade B). Patients with gallstones along with common bile duct stones treated by endoscopic sphincterotomy should undergo cholecystectomy (grade A). Laparoscopic cholecystectomy with laparoscopic common bile duct exploration or with intraoperative endoscopic sphincterotomy is the preferred treatment for obstructive jaundice caused by common bile duct stones, when the expertise and infrastructure are available (grade B).
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Maternal and fetal near-term sheep cytokine responses to carbon dioxide pneumoperitoneum. Surg Laparosc Endosc Percutan Tech 2009; 19:138-41. [PMID: 19390281 DOI: 10.1097/sle.0b013e31819756bf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
It is known that carbon dioxide (CO2) pneumoperitoneum induces fetal acidosis in pregnant ewes. Our aim was to determine changes of the levels of maternal and fetal cytokines interleukin-6, interleukin-8, and tumor necrosis factor alpha after CO2 pneumoperitoneum in pregnant ewes. Eight ewes with singleton pregnancies of 120 to 140 days gestation were anesthetized and intubated. Insufflation produced modest but significant maternal arterial hypercapnia (an increase of 10.7 mm Hg; P<0.001) and acidosis (a decrease in mean pH of 0.1.04; P=0.0005). Fetal pCO2 was increased by 15.3 mm Hg on average and pH was decreased by 0.11 U on average immediately after desufflation (both P<0.001). No significant difference was observed in the concentration of cytokine in the maternal or fetal blood samples. These results suggest that respiratory acidosis does not lead to the elevation of cytokines in pregnant ewes and fetuses, which may contribute to premature labor.
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Abstract
Laparoscopic cholecystectomy (LC) has supplanted open cholecystectomy for most gallbladder pathology. Experience has allowed the development of now well-established technical nuances, and training has raised the level of performance so that safe LC is possible. If safe cholecystectomy cannot be performed because of acute inflammation, LC tube placement should occur. A systematic approach in every case to open a window beyond the triangle of Calot, well up onto the liver bed, is essential for the safe completion of the operation.
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Affiliation(s)
- Demetrius E M Litwin
- Department of Surgery, University Campus, 55 Lake Avenue North, The University of Massachusetts Medical School, Worcester, MA 01655, USA.
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15
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Munerato MS, Zanetti EDS, Marques JA, Duarte JMB. Effects of laparoscopy on the cardiorespiratory system of brown brocket deer (Mazama gouazoubira) anesthetized with ketamine/ xylazine/ midazolam combination and isoflurane. PESQUISA VETERINARIA BRASILEIRA 2008. [DOI: 10.1590/s0100-736x2008001100003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Laparoscopy is not widely used as a tool to perform assisted reproduction techniques in South American cervids; thus, scarce information in literature is available regarding its effects and appropriate anesthetic protocols to perform it. This study evaluated the effect of laparoscopy on heart rate (HR), respiration rate (RR), saturation of oxyhemoglobin (SpO2) and rectal temperature (RT) of six female brown brocket deer (Mazama gouazoubira) anesthetized with ketamine (5mg/kg), xylazine (0.3mg/kg), midazolam (0.5mg/kg) combination i.v. and isoflurane. Twelve laparoscopies were performed and each animal was used twice with a 40-day interval. After anesthetized, the animals were placed in dorsal recumbency to perform laparoscopy procedure using abdominal CO2 insufflations (14.2 ± 2.39mmHg; M ± SE). The main events of the laparoscopy procedure were divided into three periods: animal without (P1) and with abdominal insufflation (P2) and abdominal insufflation with the hips raised at 45º (P3). As a control, the animals were anesthetized again 40 days after the last laparoscopy, and were maintained in a dorsal recumbency for the same average duration of the previous anesthesia and no laparoscopy procedure was conducted. The period of anesthesia for the controls was also divided into P1, P2, and P3 considering the average duration of these periods in previous laparoscopies performed. Data were analyzed through the (ANOVA) variance analysis followed by Tukey test and values at P<0.05 were considered significant. No significant differences were observed in the parameters evaluated at P1, P2 and P3 between the animals submitted to laparoscopy and control. However, the RR mean between P1 (38.8 ± 4.42) and P3 (32.7 ± 4.81); and the RT mean between the P1 (38.2ºC ± 0.17), P2 (37.6ºC ± 0.19) and P3 (37.0ºC ± 0.21) varied significantly, independent of the laparoscopy. These data indicated that laparoscopy didn't cause any significant alterations in the cardiorespiratory parameters evaluated, even though the anesthetic protocol used can cause a reduction in the RT contributing to development of hypothermia during anesthesia.
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16
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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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17
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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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Amoli HA, Tavakoli H, Notash AY, Far MS, Khashayar P. [Not Available]. J Minim Access Surg 2008; 4:9-14. [PMID: 19547671 PMCID: PMC2699057 DOI: 10.4103/0972-9941.40991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Accepted: 01/08/2008] [Indexed: 11/04/2022] Open
Abstract
This study was conducted to evaluate the safety of laparoscopic cholecystectomy (LC) during pregnancy. Patients who underwent LC were selected from several hospital databases, only six were performed during pregnancy. In this series, one of the two patients who had LC in the first trimester underwent elective termination of pregnancy while the other one gave birth to a term child normally. Half of the four who had the second trimester LC had normal deliveries at term whereas for the other two cesarean section was performed. None of our patients underwent LC in the third trimester. The findings of the present study suggest LC to be a safe procedure performed during the first and second trimester of pregnancy.
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Affiliation(s)
- Hadi Ahmadi Amoli
- Department of Surgery, Tehran University of Medical Science, Tehran, Iran
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19
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Jelin EB, Smink DS, Vernon AH, Brooks DC. Management of biliary tract disease during pregnancy: a decision analysis. Surg Endosc 2007; 22:54-60. [PMID: 17713817 DOI: 10.1007/s00464-007-9220-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2006] [Revised: 08/27/2006] [Accepted: 10/09/2006] [Indexed: 12/14/2022]
Abstract
BACKGROUND The appropriate management of biliary tract disease during pregnancy is uncertain. Although laparoscopic cholecystectomy can be performed safely during pregnancy, the timing and indications for this surgical intervention have not been firmly established. METHODS We constructed a Markov decision analytic model that incorporates maternal well-being and fetal outcome into a choice between nonoperative management (NM) and laparoscopic cholecystectomy (LC) for pregnant women with biliary tract disease (BTD). Our model cycles through weeks of pregnancy for a cohort of 200 gravid women presenting with biliary tract disease in both the first and second trimesters. Weekly state probabilities and utilities for fetal outcome were derived from the literature, while weekly utilities for disease and operative states were estimated in consultation with obstetricians. We cycled the model from 6 to 42 weeks and from 19 to 42 weeks to simulate first and second trimester presentations. Outcomes are expressed in quality pregnancy weeks (QPWs). One QPW is the utility of a normal healthy week of pregnancy. RESULTS A comprehensive search of the literature yielded a fetal death rate following LC for biliary tract disease of 2.2% and following NM of 7%. Relapse rates were found to be trimester dependent and estimated to be 55%, 55%, and 40% in the first, second, and third trimester, respectively. For a hypothetical cohort of 100 women presenting with biliary tract disease in their first trimester, LC generated 12,800 QPWs compared with 12,400 QPWs for NM, an average gain of 4 QPWs per woman. For the cohort of women entering the model in the second trimester, 11,600 QPWs were accrued by the LC group and 11,400 QPWs by the NM group, an average gain of 2 QPWs per woman. These findings were sensitive only to changes in fetal death rates under the two treatment arms. CONCLUSIONS Laparoscopic cholecystectomy is superior to nonoperative management for pregnant women presenting in the first or second trimester with biliary tract disease.
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Affiliation(s)
- Eric B Jelin
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
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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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21
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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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22
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Griffiths J, Sia W, Shapiro AMJ, Tataryn I, Turner AR. Laparoscopic splenectomy for the treatment of refractory immune thrombocytopenia in pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2006; 27:771-4. [PMID: 16287009 DOI: 10.1016/s1701-2163(16)30729-0] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Immune thrombocytopenic purpura (ITP) is a condition with potential hazard during pregnancy for both mother and fetus if platelet concentrations fall below a critical level. This report describes the use of laparoscopic splenectomy following unsuccessful medical management. CASE A 35-year-old primigravid woman with systemic lupus erythematosis (SLE) developed ITP several years before becoming pregnant. She was treated early in pregnancy with high-dose oral prednisone and weekly intravenous immunoglobulin (IVIG) alternating with anti-D immune globulin, but laparoscopic splenectomy was indicated at 20 weeks' gestation because of thrombocytopenia. Following surgery, she continued prednisone and intermittent IVIG therapy until spontaneous delivery at 34 weeks' gestation. A small accessory spleen was identified postpartum by nuclear medicine scan. Satisfactory platelet concentrations were maintained postpartum using danazol and prednisone. CONCLUSION Laparoscopic splenectomy is a therapeutic option for women with ITP during pregnancy that fails to respond to medical management.
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Affiliation(s)
- Jill Griffiths
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton AB
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23
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Are C, Raman SP, Ravipatti N, Talamini M. Decreased Porcine Uterine Blood Flow During Laparoscopic Nissen Fundoplication. J Gynecol Surg 2004. [DOI: 10.1089/gyn.2004.20.113] [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)
- Chandrakanth Are
- Department of General Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Siva P. Raman
- The Johns Hopkins University School of Medicine, Baltimore, MD
| | - N. Ravipatti
- The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mark Talamini
- Department of Surgery and Minimally Invasive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
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24
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Abstract
Advances in laparoscopic surgery have led to the development of methods to perform traditionally major abdominal surgery and reduce morbidity using minimally invasive surgery techniques. Because a growing number of reports in the literature have suggested its safe use, laparoscopy is being performed in pregnancy with increasing frequency in many centers. Any surgeon treating pregnant patients must have a thorough understanding of the physiology of the pregnant patient and risks and benefits of the surgical procedure. This article discusses the use of laparoscopy in pregnancy focusing on the physiologic changes induced by pregnancy relevant to laparoscopy. Strategies to reduce the risk of complications while performing laparoscopy on a pregnant patient are discussed.
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Affiliation(s)
- Kevin Stepp
- Department of Obstetrics and Gynecology, The Cleveland Clinic Foundation, A81, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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25
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Lawes EG. Hidden hazards and dangers associated with the use of HME/filters in breathing circuits. Their effect on toxic metabolite production, pulse oximetry and airway resistance. Br J Anaesth 2003; 91:249-64. [PMID: 12878625 DOI: 10.1093/bja/aeg154] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E G Lawes
- Shackleton Department of Anaesthesia, Southampton University Teaching Hospitals, Tremona Road, SO16 6YD, UK.
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26
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Reynolds JD, Booth JV, de la Fuente S, Punnahitananda S, McMahon RL, Hopkins MB, Eubanks WS. A review of laparoscopy for non-obstetric–related surgery during pregnancy. ACTA ACUST UNITED AC 2003; 60:164-73. [PMID: 14972289 DOI: 10.1016/s0149-7944(02)00678-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE Similar to the general population, parturients (and their fetuses) could benefit from the reduced manipulation associated with laparoscopy. The purpose of this article is to review the current state of knowledge (both clinical and experimental) with respect to the fetal effects of maternal laparoscopy for non-obstetric-related surgery during pregnancy. METHODS Human and experimental animal results are examined, and we present preliminary data from our own laboratory. CONCLUSIONS Future experiments are proposed to further develop and refine standards of care for general surgeons and obstetricians who are presented with gravid females in abdominal distress.
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Affiliation(s)
- James D Reynolds
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
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27
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Abstract
Minimally invasive surgery is being performed more frequently in pregnant patients. Numerous published reports have documented the safety and advantages of laparoscopic cholecystectomy and laparoscopic appendectomy during pregnancy. Pregnancy is associated with a variety of changes in the respiratory and cardiovascular systems, which make the parturient undergoing laparoscopic surgery particularly susceptible to hypoxia, hypercarbia and hypotension. This chapter provides a review of those physiological changes of pregnancy of particular concern for anaesthesiologists, and of the physiological responses to intra-abdominal carbon dioxide insufflation, not only in healthy patients, but also in the altered physiological state associated with pregnancy. We also describe our approach to anaesthetic management for minimally invasive surgery during pregnancy. With appropriate precautions, including vigilant monitoring and anticipation and treatment of the potential adverse effects of carbon dioxide pneumoperitoneum, anaesthesiologists may provide safe care for these patients, and pregnant women can benefit from the advantages of minimally invasive surgery.
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Affiliation(s)
- Richard A Steinbrook
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
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28
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Lyass S, Pikarsky A, Eisenberg VH, Elchalal U, Schenker JG, Reissman P. Is laparoscopic appendectomy safe in pregnant women? Surg Endosc 2001; 15:377-9. [PMID: 11395819 DOI: 10.1007/s004640000368] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2000] [Accepted: 08/25/2000] [Indexed: 10/26/2022]
Abstract
BACKGROUND Because of limited laboratory and clinical data, no accepted guidelines concerning the safety of laparoscopic appendectomy (LA) in pregnancy have been established yet. In this prospective study, we evaluated the safety and outcome of LA in pregnant women as compared with the same control group of pregnant women who underwent open appendectomy (OA) during the same period. METHODS During the years 1996 to 1999, 11 consecutive pregnant women (mean age, 27 years; range 21-39 years; gestation age range, 7-34 weeks) who underwent LA were prospectively evaluated and compared with a matched group of 11 women (mean age, 30 years; range 18-42 years; gestation age range, 11-37 weeks) who underwent OA. The following parameters were analyzed: obstetric and gynecologic risk factors, length of procedure, perioperative complications, length of stay, and outcome of pregnancy. Both groups were well matched in age and risk factors for pregnancy loss. RESULTS There was no significant difference in the length of procedure (60 vs. 46 min) and the complications rate (one in each group) between the LA and OA groups, respectively. There was no conversion in the LA group. The length of postoperative stay was shorter in the LA group (3.6 vs 5.2 days; p = 0.05). There was no fetal loss or other adverse outcome of pregnancy in either group, and all the women in both groups had normal full-term delivery. The infants' development was normal in both groups for a mean follow-up period of 30 months. CONCLUSIONS According to this relatively small-scale study laparoscopic appendectomy in pregnant women may be as safe as open appendectomy. This procedure is technically feasible in all trimesters of pregnancy and associated with the same known benefits of laparoscopic surgery that nonpregnant patients experience.
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Affiliation(s)
- S Lyass
- Departments of Surgery, Hadassah Hebrew University Medical Center, P.O.B 12000, Jerusalem 91120, Israel.
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29
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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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30
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Figueiras Ramos B, Corona Martínez L, Bembibre Taboada R, Soler Morejón C, Rocha Hernández J, Fonseca Hernández M, Hernández Rodríguez Y. Valoración evolutiva de la presión intraabdominal en pacientes con cirugía abdominal. Estudio clínico observacional. Med Intensiva 2001. [DOI: 10.1016/s0210-5691(01)79681-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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31
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Curet MJ. Special problems in laparoscopic surgery. Previous abdominal surgery, obesity, and pregnancy. Surg Clin North Am 2000; 80:1093-110. [PMID: 10987026 DOI: 10.1016/s0039-6109(05)70215-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Previous surgery, obesity, and pregnancy should no longer be considered contraindications to laparoscopic surgery. Surgeons should exercise good judgement in patient selection, use meticulous surgical techniques, and prepare thoroughly for the planned procedure. Patients and surgeons should be aware of increased conversion rates. With these caveats in mind, these patients can still experience the advantages of minimally invasive surgery without increased risks.
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Affiliation(s)
- M J Curet
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, USA
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32
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Akira S, Yamanaka A, Ishihara T, Takeshita T, Araki T. Gasless laparoscopic ovarian cystectomy during pregnancy: comparison with laparotomy. Am J Obstet Gynecol 1999; 180:554-7. [PMID: 10076127 DOI: 10.1016/s0002-9378(99)70253-x] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The efficacy and safety of gasless laparoscopic ovarian cystectomy during pregnancy were compared with those of conventional laparotomy. STUDY DESIGN Subjects for the 2 study groups were selected from consecutive patients who satisfied all entrance criteria. Seventeen women who underwent gasless laparoscopic cystectomy were compared with 18 women who underwent cystectomy by laparotomy. The intraoperative and postoperative courses, pregnancy outcomes, and complications were compared. RESULTS The patients' ages, body mass indexes, mean cyst diameters, fetal gestational ages, and types of cysts did not differ significantly between the two groups. Blood loss, analgesic use, and need for tocolytic agents were significantly less in the laparoscopy group than in the laparotomy group. No abortions or preterm deliveries occurred in the laparoscopy group, whereas 1 abortion was recorded in the laparotomy group. CONCLUSION Gasless laparoscopic ovarian cystectomy offers significant advantages with respect to laparotomy for the pregnant patient.
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Affiliation(s)
- S Akira
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
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Bhavani-Shankar K, Steinbrook RA, Mushlin PS, Freiberger D. Transcutaneous PCO2 monitoring during laparoscopic cholecystectomy in pregnancy. Can J Anaesth 1998; 45:164-9. [PMID: 9512853 DOI: 10.1007/bf03013257] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Respiratory acidosis during carbon dioxide (CO2) insufflation has been suggested as a cause of spontaneous abortion and preterm labour following laparoscopic cholecystectomy during pregnancy. Capnography may not be adequate as a guide to adjust pulmonary ventilation during laparoscopic surgery and hence arterial carbon dioxide (PaCO2) monitoring has been recommended. We report the feasibility and benefits of transcutaneous carbon dioxide monitoring (PtcCO2) as an approach to optimise ventilation during laparoscopic surgery in pregnancy. METHOD A healthy parturient received general anaesthesia for laparoscopic cholecystectomy. Pulmonary ventilation was adjusted to maintain end-tidal carbon dioxide (conventional PETCO2) at 32 mmHg during CO2 insufflation. A PtcCO2 monitor was used to trend PaCO2 throughout the procedure. Mechanical ventilation was interrupted every five minutes to obtain an end-tidal PCO2 value at large tidal volume (squeeze PETCO2). RESULTS The PtcCO2 increased from 39 mmHg before induction to 45 mmHg after CO2 insufflation. This corresponds to an estimated maximum PaCO2 of 39-40 mmHg during insufflation. The PtcCO2 gradually returned to pre-induction baseline values one hour after the termination of CO2 insufflation. Squeeze PETCO2 values approximated PtcCO2 more closely than did conventional PETCO2 values (P < 0.01). CONCLUSION Continuous PtcCO2 measurements as well as squeeze PETCO2 may be of clinical value in trending and preventing hypercarbia during laparoscopic surgery.
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Affiliation(s)
- K Bhavani-Shankar
- Department of Anaesthesia, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA
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