‘Laparoscopic surgery associated with pregnancy is feasible and carries a low morbidity’

The incidence of pelvic pain requiring surgery ranges from approximately 1:440 to 1:1300. The incidence of surgery during pregnancies is approximately 0.75%. One in 600 pregnancies are complicated by the presence of adnexal masses. There are multiple concerns in abdominal operations in pregnancy, because the life of the mother and foetus must be considered

‘Laparoscopic surgery associated with pregnancy is feasible and carries a low morbidity’
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  • Earlier studies have shown that abdominal surgery in the first trimester is associated with a higher (12%) rate of spontaneous abortions, which is reduced to zero in the third trimester.
  • Adnexal  mass in pregnancy increases the rate of preterm labour: in the second trimester, it is 8% but it increases to 30% to 40% during the third trimester.

There is a growing body of evidence that laparoscopy for gynaecologic indications can be performed safely during pregnancy. We have recently compared the management of pregnant patients with symptomatic abdominal pain managed with laparoscopic surgery with those managed with laparotomy. In our study of 42 cases of adnexal mass in pregnancy, though maximum underwent laparotomy, the maternal and foetal outcome were same for laparoscopic procedures.

‘Laparoscopic surgery associated with pregnancy is feasible and carries a low morbidity’
Dr Niranjan Chavan

Risk of laparoscopy in pregnancy:

  • More chance of uterine injury during port enters as uterus becomes an abdominal organ after first trimester.
  • Problems associated with pneumoperitonisation as discussed already.
  • CO2 absorption causes increase CO2 pressure and decrease arterial PH.
  • Risk of exposure to intra-abdominal smoke including carbon monoxide generated by electro surgery and laser.

Laparoscopy and the trimester of pregnancy

Operative intervention may be performed in any trimester of pregnancy. Historical recommendations were to delay surgery until the second trimester to reduce the rates of spontaneous abortion and preterm labour. Recent literature has shown that pregnant patients may undergo laparoscopic surgery safely during any trimester without any increased risk to the mother or foetus.

Non-Gynaecological surgeries

Non-Gynaecological surgical problems complicate up to 2% to 3% of pregnancies. Symptomatic gallbladder disease is the most common reason for non-gynaecological operations during pregnancy and should be ruled out as a cause of hyperemesis gravidarum. Appendicitis, cholecystitis, pancreatitis, bowel obstruction, and trauma are the major non-gynaecological abdominal conditions noted in pregnancy that require surgical intervention.

Several studies have documented the safety of laparoscopic cholecystectomy and appendectomy during pregnancy. It has also been shown that laparotomy has a relatively higher risk of complications, increased pain, and longer hospitalisations compared with laparoscopy.

Review of Literature

Reedy et al published a paper 1997 of 413 laparoscopic procedures performed during pregnancy for general surgical and gynaecological indications appeared to result in no higher foetal or maternal complications. A foetal loss of 10% to 25% and a preterm delivery rate of approximately 20% were reported.

Affleck et al in 1999 published the largest case series of laparoscopic cholecystectomies and found no foetal losses, no birth defects, and no uterine injuries.

Carter and Soper published a paper on Laparoscopy vs. laparotomy in pregnancy in March 2005. The risk of foetal loss was found to be similar in both laparoscopy and laparotomy. However, they did advocate use of 3 mm laparoscope.

Recently, I published a case in Bombay Hospital Journal. A 25 year, G4P3L3 patient with 15 weeks of pregnancy was referred from peripheral hospital with 13x8x6cm ovarian cystadenoma. Patient underwent laparoscopic cystectomy in 2nd trimester. No antenatal complications were seen, and she delivered normally at term.


Both the Society of Gastrointestinal and Endoscopic Surgeons (SAGES) and the Society of Laparoendoscopic Surgeons (SLS) recommend obtaining access to the abdomen through an open technique, using left side-down positioning, and minimising the intrauterine pneumoperitoneum pressure to 8-mm Hg to 12-mm Hg. Laparoscopic surgery associated with pregnancy is feasible and carries a low morbidity.

The author is a Professor, Gynaecology Department at LTMG (Sion) Hospital and chairperson, FOGSI oncology committee (2012 to 2014)

  • Suman Bijlani

    Informative article useful in practice.

  • Niranjan Shah

    Any adenexal or non gynaec intervention with foetus in situ is like a no man’s land area with foetus sitting as the umpire.
    Unless until life saving the procedures to go in were taboo more so in first trimester
    With advent of advanced Laproscopy/ newer anaesthetic measures/ newer approaches n positions , the treatment to relieve the pathology n safe guard the foetus is very much possible
    This article will stand out as the few initial guideline milestones in that direction
    Kudos team Dr Chavan

  • Mohan Raut

    Excellent article Dr. Niranjan! You have opened up a new avenue not only for discussion but also for a novel approach. Congratulations!

  • Dr. Mugdha Raut

    Extremely informative. Cleared a lot of doubts. Thanks Dr. Niranjan

  • Dr KaushaL PateL

    Very much informative sir. Very few literature available focusing on this. Sir please provide some information regarding trimester wise choice of anaesthesia. Thank you.

  • Supriya Arwari

    Very well written Niranjan! Congrats

  • Dinesh Kanfade

    Very well presented & informative article.

  • Shankar

    Very resourceful article!
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