Objective: Evaluation of the fetal effects of laparoscopic surgery during pregnancy
Design: Case seriesSetting: Department of Obstetrics and Gynecology, Osaka City Sumiyoshi HospitalPatients: Twelve pregnant women who underwent laparoscopic surgery because of an adnexal mass in the first trimester. In six women, uterine artery resistant index (RI), umbilical artery and fetal heart rate were measured.
Interventions: Laparoscopic surgery (anesthesia and pneumopetioneum).Main outcome measures: Maternal complications, pregnancy loss, as well as intraoperative fetal heart rate and umbilical artery RI.Results: Gestational age ranged from 9 to 14 weeks, mean operative time was 100 minutes (range: 51-140 minutes), mean anesthesia time was 146 minutes (range: 76-190 minutes), pneumoperitoneum pressure was ≤8 mm Hg, mean pneumoperitoneum time was 43 minutes (17-69 minutes), and mean duration of tocolysis was 5 days (range: 3-8 days).During laparoscopic surgery, the fetal heart rate remained normal, but umbilical artery RI increased. Mean umbilical artery RI increased was 0.070 mm Hg after induction of anesthesia and further increased by 0.015 mm Hg after the establishment of a pneumoperitoneum. Mean uterine artery RI decrease after induction of anesthesia was 0.220 mm Hg; however, it increased 0.110 mm Hg after establishment of pneumoperitoneum. Fetal heart rate remained in normal. All pregnancy outcomes were normal.Conclusions: Laparoscopic surgery in pregnancy incurred no maternal complications. However, fetal distress may occur during the procedure. Thus, it is prudent to minimize the duration of anesthesia and pneumoperitoneum.
We report a case of left mucinous borderline ovarian tumor and right ovarian and tubal absence. A 36-year-old patient felt discomfort in her lower abdomen and visited our hospital for further examination. Magnetic resonance imaging (MRI) revealed an approximately 16-cm multilocular tumor. The tumor of the right ovary was extracted via laparoscopically assisted cystectomy. Intraoperatively, we noticed the absent left adnexa. Pathological examination revealed that the right ovarian tumor was a mucinous borderline tumor. During the follow-up, no postoperative recurrence was observed. Two causes have been identified for congenital absence of unilateral ovary and fallopian tube, namely congenital developmental defect and torsion of the adnexa. The present case likely resulted from an asymptomatic torsion because of the absence of other genitourinary anomalies and the strong adherence of the left fallopian tube angle to the sigmoid colon despite that the patient had no surgical history.
Isolated fallopian tube torsion is a rare disease; however, a paraovarian cyst may be a factor in inducing torsion. If an ovarian cyst exceeds 6 cm in diameter, the likelihood of adnexal torsion is high; thus, this situation is considered to be an indication for resection. A paraovarian cyst presents an equal likelihood of torsion; therefore, its presence also has a similar surgical indication. We experienced a case of a fallopian tube torsion that occurred with a paraovarian cyst of only 3 cm in diameter. When lower abdominal pain first occurred, this cyst was not considered to be its origin. We diagnosed the torsion three days after the onset of lower abdominal pain by preoperative computed tomography. At laparoscopy, the fimbria of the fallopian tube exhibited necrosis; therefore, we were forced to perform a salpingectomy.The literature contains reports of torsion of a normal fallopian tube and torsion of a hydrosalpinx; thus, it is necessary for gynecologists and emergency department physicians to recognize that tubal torsion can occur under these conditions as well as with a small paraovarian cyst.
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