Laparoscopic Surgery in the Pregnant Patient: Results and Recommendations

BACKGROUND: The complete experience of a single surgeon in a rural hospital over more than 11 years was evaluated with respect to laparoscopic operations performed on pregnant patients. METHODS: A retrospective analysis of all laparoscopic operations was carried out with respect to number and types of operations, stage of pregnancy, complications, and fetal outcomes. RESULTS: Between October 1995 and January 2007, 36 laparoscopic operations were conducted on 36 pregnant patients. This represents the largest single-surgeon case experience ever reported for nonobstetric laparoscopic surgery performed during pregnancy. The majority of cases were conducted for symptomatic gallbladder disease. There was one complication of uterine penetration by a cannula, early in the series, without fetal injury. Operations were conducted in each trimester, including the late third trimester, with 100% live births of normal infants. CONCLUSION: Laparoscopic surgery can be safely conducted in pregnant patients, in any trimester. Pregnancy should no longer be considered a contraindication to laparoscopic surgery. The limiting factor of prime importance is an awareness of one's own capabilities and limitations. The surgeon must be skilled in advanced laparoscopic techniques and in surgical obstetrics. A rural hospital setting is suitable for this type of procedure if there is a strong support structure in place to deal with potential complications.