Gynecologic Laparoscopy in Pregnancy: Tips and Tricks

INTRODUCTION: Laparoscopy is the preferred approach for patients requiring gynecologic surgical management during pregnancy. Surgical timing and technique require several unique challenges to optimize pregnancy and patient outcomes. OBJECTIVE: To highlight evidence-based practices for gynecologic laparoscopy in pregnancy, including surgical indications, perioperative considerations for maternal and fetal safety, and intraoperative techniques. METHODS: This video reviews techniques for perioperative and surgical optimization of laparoscopic surgery in pregnancy while highlighting hands-on techniques with the assistance of a case presentation: A 20-year-old G1P0 at 14 weeks of gestation presented with a 10.5-cm simple-appearing right adnexal cyst incidentally found on her dating ultrasound at 10 weeks of gestation. Repeat imaging showed persistence of the cyst. At the time of surgical removal, several aspects of patient positioning, intra-abdominal pressure and CO2 insufflation parameters, strategies for uterine manipulation and exposure, and removal techniques were employed to minimize pregnancy impact. RESULTS: The patient underwent an uncomplicated laparoscopic right ovarian cystectomy at 16 weeks of gestation with final pathology demonstrating serous cystadenoma. She progressed to have an uncomplicated remainder of the pregnancy and term vaginal delivery. CONCLUSIONS: While the fundamentals of gynecologic laparoscopy remain unchanged for pregnant patients, strategies to troubleshoot and navigate challenges posed by the gravid uterus are essential.