Gasless laparoscopy under epidural anaesthesia for adnexal surgery in pregnancy

Abstract

The elimination of the need for a pneumoperitoneum, by use of a mechanical abdominal wall elevation device, the use of epidural anaesthesia, an open laparoscopic entry technique and the avoidance of multiple laparoscopic trocar sites allowed for the safe, effective, and rapid treatment of symptomatic adnexal pathology in two pregnant patients during the second trimester of pregnancy. The first case required the removal of a 10×13‐cm dermoid cyst with torsion of its pedicle, and appendectomy. The second patient underwent the removal of symptomatic, large, bilateral endometriomas. Our experience suggests that in selected cases, this minimally invasive approach can successfully replace laparotomy and its associated morbidity, and avoid the potentially deleterious effects of arbon dioxide pneumoperitoneum and general anaesthesia upon the fetus and pregnant mother.

Removal of a Giant Cyst of the Left Ovary from a Pregnant Woman in the First Trimester by Laparoscopic Surgery under Spinal Anesthesia during the COVID-19 Pandemic

“…Pelosi et al presented two cases, in their second trimester of pregnancy, who were operated upon in gasless laparoscopy under epidural anesthesia [25]. Inoue et al applied locoregional anesthesia combining epidural-spinal anesthesia in the second trimester of pregnancy [26].…”