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Laparoscopic surgery is currently accepted as the standard of care for the management of adnexal pathology. The safety of laparoscopy during pregnancy has not been fully evaluated. Potential advantages of this approach for the pregnant women include less postoperative pain and more rapid recovery, which in turn may reduce the danger of thromboembolism. The concerns include potential direct trauma to the uterus or fetus, compromise of the uteroplacental perfusion due to increased intra-abdominal pressure associated with carbon dioxide insufflation, and carbon monoxide (CO) poisoning as a result of exposure to smoke generated by thermal energy in the form of laser surgery or bipolar desiccation. The aim of this study was to evaluate the outcome of pregnancy in a series of 29 pregnant women undergoing laparoscopic surgery for the management of an adnexal mass in the first 4 months of gestation. Of the 29 women 1 had a first trimester abortion, and 1 delivered prematurely (32w, 2126g). Of the 24 pregnancies reaching term and available for follow-up, 2 resulted in newborns with congenital malformations. In addition, we determined exposure to CO in 27 healthy nonsmoking nonpregnant women, undergoing laparoscopic procedures during which smoke was generated. The mean±SD blood carboxyhemoglobin concentrations, measured using gas chromatography, significantly decreased (p<0.001) from 0.70%±0.15%(range 0.44%-1.20%) before surgery to 0.58%±0.20% (range 0.30%-1.33%) after surgery. We conclude that CO poisoning can be avoided by aggressive smoke evacuation, and elimination of CO through hyperventilation during anesthesia. Laparoscopic surgery appeared to be safe during pregnancy, although controlled studies are needed.

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Seidman, D., Nezhat, C., Nezhat, F. et al. IS LAPAROSCOPIC SURGERY SAFE DURING PREGNANCY? 657. Pediatr Res 39, 112 (1996) doi:10.1203/00006450-199604001-00679

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