Laparoscopic Surgery During Pregnancy

Estimates suggest that up 2% of pregnant women undergo anesthesia for surgical procedures unrelated to delivery in the United States. 10,35 In the past decade, laparoscopic procedures have become increasingly popular owing to decreased morbidity and convalescence compared with open procedures. 13 Although pregnancy was considered a contraindication to laparoscopic cholecystectomy less than a decade ago, 19 it has become the most commonly performed laparoscopic procedure during pregnancy. 28 Other types of laparoscopic surgeries performed safely during pregnancy that have been reported include appendectomy, 1 cystectomy, 4 management of adnexal torsion, 7 diagnostic laparoscopies for abdominal pain, 28 splenectomy, 23 heterotopic pregnancies, 41 and adrenal pheochromocytoma. 16 Over 500 laparoscopic procedures during pregnancy have been reported, 28 and as surgeons and anesthesiologists become more comfortable with the laparoscopies in parturients, the procedures could become routine. When faced with providing anesthesia for the pregnant patient undergoing laparoscopic surgery, the anesthesiologist must not only consider the maternal and fetal issues, and prevention of preterm labor, but also pay special attention to patient positioning during surgery and the physiologic and mechanical effects of the CO 2 pneumoperitoneum.