Minilaparoscopic cystectomy and appendectomy in late second trimester

Abstract

Background and objectives: Laparoscopic ovarian cystectomy and appendectomy during the early second trimester have been widely reported. However, the use of both procedures in advanced gestation is rare. We propose a minilaparoscopic approach for performing these 2 procedures in a woman 24-weeks pregnant.

Methods: We describe the case and laparoscopic management of acute abdominal pain at the 24th week of pregnancy. Microlaparoscopy under ultrasound guidance was used for the first trocar insertion to prevent injury to the uterus. It was followed by minilaparoscopic ovarian cystectomy and appendectomy.

Results: Premature contractions occurred after the operation, but they were controlled with a single tocolytic agent, and an apparently healthy female baby was born uneventfully via Cesarean delivery at 41 weeks of gestation.

Conclusion: Minilaparoscopic ovarian cystectomy and appendectomy can be carried out in the late second trimester without serious sequela.

Figure 1.

Abdominal port placements, with a circle marking the upper limits of the uterus. A Veress needle with a 2-mm cannula was inserted then replaced by the 5-mm trocar (A).

Figure 2.

Microlaparoscopic panoramic view of the pelvis (U = uterus; O = ovarian cyst).