Pregnancy-preserving Laparoendoscopic Single-site Surgery for Gynecologic Disease: A Case Series

J Minim Invasive Gynecol. Nov-Dec 2020;27(7):1588-1597. doi: 10.1016/j.jmig.2020.02.009. Epub 2020 Feb 29.

Abstract

Study objective: The study objective was to assess the feasibility of laparoendoscopic single-site surgery (LESS) for the management of nonobstetric, gynecologic disease processes in pregnant patients.

Design: A retrospective case series of 13 pregnant women aged 21 to 42 years who underwent LESS for various gynecologic pathology. If able to be contacted, the patients were followed up until the delivery of the fetus.

Setting: The surgeries were performed in a single institution between January 2015 and June 2019.

Patients: The patients were selected if a laparoscopic intervention was indicated.

Interventions: The cases included 6 ovarian cystectomies and 2 salpingo-oophorectomies for adnexal masses; 1 myomectomy for a degenerated myoma; 1 salpingectomy for a heterotopic pregnancy; 2 cerclage placements for recurrent pregnancy loss and cervical insufficiency; and 1 paratubal cystectomy. The patients underwent LESS through a 2.5-cm umbilical incision. The masses were exteriorized using a laparoscopic specimen retrieval bag, with the exception of 2 large adnexal masses, which were aspirated at the incision site, exteriorized after content drainage, and cystectomies performed extracorporeally. The fascial incision was repaired with a permanent suture.

Measurements and main results: Various data were collected from patients, including age, surgical and obstetric history, gestational age at surgery, and ultrasonic imaging results. The outcomes measured were operative duration, intraoperative bleeding, postoperative symptoms, fetal monitoring before and after surgery, pathologic findings, conversions, intraoperative complications, and pregnancy outcomes. Eight cases were performed in the first trimester, 4 in the second trimester, and 1 in the third trimester, with the surgeries lasting between 45 minutes and 298 minutes. The blood loss ranged from 5 mL to 300 mL, and postoperative symptoms of mild pelvic or abdominal pain were reported. There were 2 conversions to traditional multiport laparoscopic surgery for the 2 cerclage cases, and there were no open surgery conversions or intraoperative complications. The fetal heart rate ranged between 130 beats per minute and 167 beats per minute postoperatively. Of the 9 patients who were able to be contacted for follow-up, all had successful deliveries. One patient was healthy at 31 weeks and 5 days without complication at the time of her last follow-up.

Conclusion: LESS may be performed by experienced surgeons on gravid patients in any trimester for adnexal masses, myomas, heterotopic pregnancy, and cervical incompetence. Future multiple-center studies may provide further evidence that LESS is a feasible and safe option for gynecologic surgery during pregnancy.

Keywords: Abdominal cerclage; Adnexal mass; Gynecologic surgery in pregnancy; LESS; Single-incision surgery.

Publication types

  • Case Reports

MeSH terms

  • Abortion, Spontaneous / prevention & control*
  • Adnexal Diseases / surgery*
  • Adult
  • Endoscopy / methods*
  • Female
  • Gynecologic Surgical Procedures / methods*
  • Humans
  • Laparoscopy / methods*
  • Organ Sparing Treatments / methods
  • Ovarian Cysts / surgery
  • Ovariectomy / methods
  • Pregnancy
  • Pregnancy Complications, Neoplastic / surgery
  • Retrospective Studies
  • Salpingectomy / methods
  • Surgical Instruments
  • Young Adult