Laparoscopic Surgery in the Pregnant Patient-One Surgeon's Experience in a Small Rural Hospital

OBJECTIVES: The laparoscopic treatment of urgent surgical conditions that develop in pregnant patients has not been extensively addressed in the current literature. It is a potential issue to which surgeons, especially rural surgeons, should give careful consideration, prior to being faced with an urgent situation during the delivery process. This report details 1 surgeon's experience over a 5-year period with laparoscopic surgery in the pregnant patient, primarily laparoscopic cholecystectomy, at a small rural Nebraska hospital. METHODS: Eleven laparoscopic operations were conducted in 10 patients. RESULTS: One patient underwent 2 separate operations: cholecystectomy at 6 weeks gestation and reduction of ovarian torsion/appendectomy at 20 weeks. One patient, at term, underwent combination cesarian delivery and laparoscopic cholecystectomy. Three patients underwent laparoscopic cholecystectomy during their third trimester of pregnancy. All patients had severe signs and symptoms that threatened successful term gestation and/or failed attempts at conservative medical management aimed at delaying cholecystectomy until after delivery. One complication occurred involving uterine perforation with a blunt 10-mm port canula. No fetal injury occurred, and after initial recovery from the cholecystectomy, the baby was successfully delivered later in the pregnancy via cesarian delivery without adverse sequelae. CONCLUSION: Urgent laparoscopic operations can be carried out successfully in pregnant patients throughout their pregnancy, even in remote locations lacking immediate on-site availability of subspecialty care. The surgeon must be skilled in surgical obstetrics and well trained and experienced in advanced laparoscopic techniques. It is recommended that the same lines of communication and referral for subspecialty involvement be in place as would be required in the management of premature delivery of pregnant patients without surgically urgent disease. Such lines of communication should be developed before the actual need arises. The rural surgeon must have a plan of action well in advance of that first encounter or any subsequent complication.