Laparoscopic procedures in pregnancy

As the applications of laparoscopy for general surgical procedures expanded in the 1990s, pregnancy was initially considered a contraindication. Several case reports have suggested the safety of laparoscopy in pregnancy. Previous clinical studies indicate a higher fetal mortality may exist and advised caution. To evaluate the fetal outcome of laparoscopic procedures in pregnant patients at our institution, we retrospectively reviewed the medical records between 1991 and 1997 and identified 21 pregnant patients who underwent either a laparoscopic (n = 12) or open (n = 9) procedure. Appendectomies, cholecystectomies, and diagnostic laparoscopies were performed. Specific variables including age, length of procedure, hospital stay, duration of parenteral analgesic use, gestational age at the time of surgery and delivery, O2 saturation and EtCO2 during surgery, APGAR scores, and birth weights were compared between the two groups. Laparoscopic procedures during pregnancy resulted in shorter hospital stays (34 hours versus 91 hours; P = 0.01), less use of parenteral narcotic analgesics (5 hours versus 29 hours; P = 0.05), and no prolongation of operative times (51 minutes versus 63 minutes; P = 0.20). In addition, laparoscopy was performed at earlier gestational ages (12 weeks versus 29 weeks; P = 0.001). There was one miscarriage 7 days after a laparoscopic cholecystectomy early in the 1st trimester that was not statistically significant. Our experience did not show a higher incidence of fetal loss when comparing laparoscopic to open procedures in pregnant patients.