Grand Rounds: Laparoscopy for adnexal masses in pregnancy?

Now that laparoscopy during pregnancy is no longer considered too dangerous, should you remove a mass this way-and if so, when?

Key Points

Laparotomy. In the past, pregnant patients who required surgical evaluation of a persistent adnexal mass underwent a laparotomy. Pregnancy was considered an absolute contraindication for laparoscopy due to the unknown effects of increased intra-abdominal pressure on a gravid uterus. That has changed within the last decade, however, as several studies comparing laparoscopy and laparotomy in pregnancy found no difference in fetal outcome between these two procedures.11,12 Furthermore, laparoscopy is commonly successful during pregnancy, with only a 3% conversion to laparotomy.13

Benefits of laparoscopy. Overall, laparoscopy is increasingly being chosen, given its many benefits over laparotomy, which are possibly even more substantial for pregnant patients. Intraoperatively, there's often less uterine manipulation when compared with laparotomy.14 Postoperatively, patients have shorter hospital stays, earlier mobilization, and a lower risk of thromboembolic events.15 Furthermore, avoidance of an abdominal scar in the face of a growing uterus can lead to less postoperative discomfort and a better cosmetic outcome.13,16

When is surgery indicated?