Gasless laparoendoscopic single-site surgery for management of adnexal masses during pregnancy

To evaluate the safety and feasibility of gasless transumbilical laparoendoscopic single-site (LESS) surgery with abdominal-wall lift method for the management of adnexal masses during pregnancy.

Retrospective study of 29 women each undergoing gasless LESS surgery and multiport laparoscopic surgery for the management of adnexal masses during pregnancy. The two groups were compared for their surgical and pregnancy outcome measures.

Conceptions occurred spontaneously in all women including 2 cases each of monochorionic-diamniotic twins in both groups. Three and 2 cases of bilateral adnexal masses were noted in the LESS surgery group and the multiport laparoscopic surgery group, respectively. Estimated gestational age at surgery was significantly older and tumor diameter was significantly larger in the LESS surgery group than in the multiport laparoscopic surgery group. However, significant differences between the two groups were not evident in other patient demographics. There were no significant differences in type of surgery between the two groups. In 28 masses that received LESS adnexal cystectomy, LESS-assisted extracorporeal cystectomy was achieved in 23 masses. Excised tissue weight in the LESS surgery group was significantly heavier than in the multiport laparoscopic surgery group. Significant differences were not observed in other operative parameters between the two groups. Significant differences in postoperative complications were not identified between the two groups. Benign pathologies were obtained in 61 masses from both groups, except for a case of clear cell carcinoma managed by LESS salpingo-oophorectomy. Significant differences in pathological diagnosis were not observed between the two groups. Delivery of 61 neonates occurred in 57 women except for the case of clear cell carcinoma in which termination of the pregnancy was chosen. In the LESS surgery group, threatened premature delivery requiring admission and preterm delivery was noted in 3 and 4 cases, respectively. However, significant differences in pregnancy outcomes were not identified between the two groups. The neonatal course was uneventful in all infants.

Gasless LESS surgery for adnexal masses during pregnancy is a safe and feasible alternative to multiport laparoscopic surgery, with the avoidance of potential negative effects of carbon dioxide gas insufflation on mother and fetus.