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Laparoscopic management of adnexal masses in pregnancy: a case series
Patrice Mathevet1, Karima Nessah, Daniel Dargent
1Department of Obstetrics and Gynecology, Pavillon L, Hopital E. Herriot, Place d'Arsonval, 69437 Cedex O3, Lyon, France. patrice.mathevet@chu-lyon.fr
Objective:
To determine the feasibility, safety, limiting factors, and advantages of laparoscopic management of adnexal masses in pregnancy.
Study Design:
During a 12-year period, 48 laparoscopic procedures were performed in 47 patients with adnexal masses in pregnancy. Laparoscopic surgery was done during the first trimester of pregnancy in 17 cases, the second trimester in 27 cases and the third trimester in four cases. All the procedures were performed with general anesthesia and curarization. The laparoscopic cystectomies were performed either with the intra-peritoneal or the trans-peritoneal technique.
Results:
The indications were: persistant or sonographically abnormal ovarian cyst (36 cases), torsion or rupture of ovarian cyst (8 cases), and symptomatic pelvic mass (3 cases). Two borderline tumors were discovered. The laproscopic procedure could not be performed in two cases due to dense adhesions and difficulty of hemostasis. No patient encountered complications during the intra- and post-operative periods. The mean hospital stay was 3.8 days. The outcome of the pregnancy was normal in all cases except one fetal loss 4 days after the laparoscopy.
Conclusion:
Laparoscopic management of adnexal masses in pregnancy by an experienced team, is a safe and effective procedure that allows, compared to the traditional surgery, a shorter hospital stay, a reduced rate of post-operative complications and a decreased maternal and fetal morbidity.