Title: An Interdisciplinary Challenge- Growing Interest on Laparoscopic Surgery during Early & Advanced Stage of Pregnancy
Authors: Dr Arati Nayak, Dr Arata Kumar Swain, Dr Pradipta Kumar Patel, Dr Girija Sankar Patra
DOI: http://dx.doi.org/10.18535/jmscr/v4i7.39
A literature search was performed using Medline and the search engine Google. Criteria for selection of literature were methods of analysis (statistical or non statistical), operative procedure (only universally accepted procedures were selected) and the institution where the study was done (Specialized institution for laparoscopic surgery).Approximately 1 in 500 to 1 in 635 women will require non-obstetrical abdominal surgery during their pregnancies (1.2). The most common non-obstetrical surgical emergencies complicating pregnancy are acute appendicitis, cholecystitis, and intestinal obstruction (1). Laparoscopic surgery in the pregnant patient is not yet broadly accepted; concern has been for fetal wastage, effects of carbon dioxide (CO2) on the developing fetus, and long-term sequelae during childhood development. The anesthesiologist must be aware of the physiologic changes associated with pregnancy and the effects of positioning, and the consequences of CO2 pneumoperitoneum on the parturient and the fetus. Important factors in laparoscopic surgery – risk of aspiration, Supine hypertensive syndrome. Pneumoperitoneum during pregnancy results in more pronounced restrictive lung physiology. Avoid hypoxemia, hypotension, acidosis, hypoventilation, and hyperventilation. Anesthesiologists must maintain a high index of suspicion for complications such as gas embolism, extraperitoneal insufflations surgical emphysema, pneumothorax and pneumomediastinum. Invasive monitoring could be required in those patients with significant cardiovascular or pulmonary disease.Now a days Minimally invasive surgery is being performed more frequently in pregnant patients. Literatures suggest that Laparoscopic surgery during pregnancy is safe, has multiple advantages over open techniques and can be performed during all gestational ages. 1. Kammerer WS (1979) Nonobstetric surgery during pregnancy. The Medical clinics of North America 63:1157-1164. 2. Kort B, Katz VL, Watson WJ (1993) The effect of nonobstetric operation during pregnancy. Surgery, gynecology &obs 3. Barone JE, Bears S, Chen S, Tsai J, Russell JC. Outcome study of cholecyste-ctomy during pregnancy. Am J Surg. 1999;177:232-236. tetrics 177:371-376. 4. Gurbuz AT, Peetz ME. The acute abdomen in the pregnant patient. Is there a role for laparoscopy? SurgEndosc. 1997;11:98-102. 5. Mendelson CL. Aspiration of stomach contents into the lungs after obstetric anesthesia. Am J Obstet Gynecol. 1946;52:191-205. 6. Graham G, Baxi L, Tharakan T. Laparo-scopic cholecystectomy during pregnancy: a case series and review of the literature. ObstetGynecolSurv. 1998;l9:556-574. 7. Curet MJ. 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Barnard JM, fetal response to carbon dioxide pneumoperitoneum in pregnant ewe; obstetgynecol 1995; 85: 664-74. 15. Hunter JG, carbon dioxide pneumoperitoneum induces fetal acidosis in a pregnant ewe model. Surgical endoscopy 1995; 9:272-279. 16. Garcia-Oria M, histologic evaluation of fetal brains following maternal pneumoperitoneum. J surgical endoscopy vol 15 n 11 November 2001. 17. Al Fozan H, safety and risks of laparo-scopy in pregnancy. Current opinion in obs and gyn; 14 (4) 375-379: August 2002. 18. Reedy MB, laparoscopy during pregnancy: a study of five fetal outcome parameters with the use of the Swedish health registry. Am J obstetgynecol 1997; 177: 673-679? 19. Al Fozan H, safety and risks of laparoscopy in pregnancy. Current opinion in obs and gyn; 14 (4) 375-379: August 2002. 20. Bhavani-Shankar K, arterial to end- tidal carbon dioxide pressure differences during laparoscopic surgery in pregnancy. Anes-thesiology 93 (2); 370-373: August 2000. 21. Guidelines for laparoscopic surgery during pregnancy. SAGES. Surgery endoscopy 1998 12(2): 189-190. 22. Soper NJ, Hunter JG, laparoscopic cholecystectomy during pregnancy. Surg endoscopy 1992; 6: 115-117. 23. Williams JK, laparoscopic cholecystectomy during pregnancy, a case report. J reprod surgery 1995; 40:243-254 24. Spirtos NM, laparoscopy a diagnostic aid in case of suspected appendicitis. Am j obstetgynecol 1987; 156: 90-94. 25. Schreiber JH, laparoscopic appendectomy in pregnancy. Surgical endoscopy 1990; 4:100-102. 26. Arvidsson D, laparoscopic cholecystectomy during pregnancy. Surg laparoscopy endoscopy 1991; 1: 193-194.Abstract
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