Gasless laparoscopic surgery during pregnancy: evaluation of its role and usefulness

The minimally invasive laparoscopic approach in the surgical treatment of diseases during pregnancy has become progressively more accepted and applied. In an attempt to overcome the potential adverse effects of pneumoperitoneum on the fetus, gasless laparoscopic surgery (GLS) has been developed. This article reviews the evidence available for the role and effectiveness of GLS in pregnancy. A computerized literature search was conducted on Medline, Science Citation Index, Current Contents, Embase, and PubMed databases for English language publications from the first report of GLS in pregnancy in 1995 to June 2012. Eleven case reports or retrospective series were identified. A total of 44 pregnant women underwent GLS for various surgical indications. In all cases, the procedures were carried out without complication, and the women were discharged from hospital with a continuing pregnancy. GLS in pregnancy has comparable outcomes to conventional CO2 laparoscopy, but it is associated with some advantages. Hypercarbia and increased intraperitoneal pressure due to CO2 insufflation are avoided. The use of high-pressure continuous suction may prevent the problems that are potentially associated with intra-abdominal smoke generated by electrosurgery, which can increase the risk of fetal exposure to elevated levels of toxic gases. Because this procedure may be performed under regional anesthesia, avoiding general anesthesia, there is a minimal transplacental passage of anesthetic drugs to the fetus. The surgeon must be expert in advanced laparoscopic procedures.