Gasless laparoscopic ovarian cystectomy with minilaparotomy during pregnancy

Objective

Recently there have been many reports of laparoscopic surgery during pregnancy, despite serious concerns about the possible consequences of fetal damage caused by the pneumoperitoneum and anaesthetics, or the risk of the trauma to the enlarged uterus. We have attempted gasless laparoscopic surgery with extra-abdominal cystectomy under regional anaesthesia for ovarian cysts in pregnancy to avoid or minimize such risks.

Interventions

We report three cases of laparoscopically assisted abdominal cystectomy during early pregnancy using a gasless method (Laparolift in two cases and surgical wire in one case) and combined spinal-epidural anaesthesia (CSE). Extra-abdominal cystectomy was performed after a minilaparotomy directly above the ovarian cyst.

Results

In all three cases, there were no intraoperative complications and postoperative recoveries were rapid and uneventful for both the mother and the fetus. Intra-abdominal procedures in gasless laparoscopy are more difficult than those with pneumoperitoneum because of the limited visual field. In respect to anaesthesia, all the patients experienced discomfort with the head-down tilt during the operation, although this position was maintained for the shortest possible period of time. However, the procedures were performed smoothly and with relative ease with extra-abdominal cystectomy. All the patients were discharged on the second postoperative day and subsequently completed their normal pregnancies with spontaneous vaginal delivery of healthy full-term babies.

Conclusion

Gasless laparoscopic cystectomy with a minilaparotomy in early pregnancy may be an alternative approach to ovarian cysts in pregnancy, considering the absence of fetal risk from CO₂ pneumoperitoneum and a relatively low risk of trauma to the enlarged uterus. With regard to the choice of anaesthesia in this approach, general anaesthesia may be preferable.