Chapter 14 Minimally Invasive Surgery

Question 1

30 yo female pregnant patient at 20 weeks AOG decided to undergo laparoscopic appendectomy. Which of the following will you advise the patient?

A) Is contraindicated due to the risk of premature labor
B) Is safe if there is no maternal respiratory acidosis during surgery
C) Should not be performed during the second trimester
D) Should not be performed with intra-abdominal pressures >1mm cm H2O pressure
E) None of the above

Answer 1

B) Is safe if there is no maternal respiratory acidosis during surgery

Laparoscopy in pregnancy

• height of the fundus reaches the umbilicus at 20 weeks
• use open Hasson’s technique
• position slightly on the left side to avoid IVC compression
• fetal acidosis may be prevented by avoiding respiratory acidosis in the mother
• mid-pregnancy contractions provide a much greater pressure in utero than a pneumoperitoneum of 15 mm Hg
• should be performed during the 2nd trimester
• heart rate decelerations might signal the need to convert to open procedure