Laparoscopic management of adnexal masses with the open entry technique in second-trimester pregnancy

Abstract

Background and Objectives: To describe laparoscopic management of adnexal mass during pregnancy between January 1994 and November 2003 and give an overview of existing literature on this subject (1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003). Design: Observational (descriptive) study with prospectively collected database supplemented by retrospective chart review. Setting: Tertiary-care referral centre. Subjects: Eleven consecutive pregnant patients with an adnexal mass. Interventions: Ten patients had laparoscopy with the open entry technique and one with the closed entry technique. Main outcome measures: Blood loss, operating time, number of conversions to laparotomy, complications and pregnancy outcome. Results: The incidence of laparoscopic management of adnexal pathology during pregnancy in our institution was 1:1,206 pregnancies (0.1%). One patient was suspected to have an ovarian malignancy, which appeared to be a large malignant tumour originating from the intestine. Ovarian malignancy was not found. In seven cases, surgery was postponed until the 16th week of gestation; however, four patients required surgery earlier in pregnancy due to suspicion of ovarian malignancy (n=1) or adnexal torsion (n=3). No entry-related or intra-operative complications occurred. Two procedures were converted to laparotomy but were not due to laparoscopic complications. One intra-uterine foetal death occurred at 24 weeks of gestation (12 weeks after adnexal detorsion). No postoperative maternal complications occurred, and nine healthy infants were born. One patient continues to have an uncomplicated pregnancy. Conclusions: Adnexal masses requiring surgical intervention can be explored laparoscopically.We advise the open entry technique in order to avoid entry-related complications, e.g. to the pregnant woman's uterus and the adnexal mass.

Laparoscopically Guided Uterine Entry for Fetoscopy in Twin-to-Twin Transfusion Syndrome with Completely Anterior Placenta: A Novel Technique

“…We report on a novel minimally invasive technique, developed to enable safe uterine entry and optimal placental visualisation in patients with completely anterior placenta by combining laparoscopy with fetoscopy. Laparoscopy with the open-entry technique has been shown before to be a safe procedure in pregnant women [12,13] .…”