Operative Laparoscopy in Pregnancy
Drs. James F. Carter,  David A. Soper
Obstetrics and Gynecology MUSC
Charleston, South Carolina

We performed a systematic retrospective chart review of pregnant women undergoing laparotomy or laparoscopy from August 1, 1993 to July 31, 1998.
Results:  Seven patients had operative laparoscopic procedures performed. The average age was 27.1 yrs (range, 24 – 34).  The mean gestational age was 13.6 weeks (range, 8-22), mean operating time was 122 minutes (range, 75-180), and the mean hospital stay was 1.1 days (range 1-2).  Pathological evaluation revealed two serous cystadenomas, one mature cystic teratoma, one peritubular cyst, two simple cysts in one ovary,  a right-sided fibroid, and severe adhesive disease.  There were no postoperative complications. There were no cases of preterm labor associated with the surgery.  Six pregnancies delivered at term and one pregnancy delivered at 34 0/7 weeks and did well.  The patient delivering at 34 weeks did so 25 weeks following her surgical procedure. Ten patients had exploratory laparotomy procedures performed with one patient being lost to follow up (though her post operative stay was uncomplicated). The average age of the laparotomy patients was 22.9 yrs. (range 19 – 35) . The mean gestational age was 13.5 weeks (range, 8 – 19). The mean operating time was 78.8 minutes (range 53 – 150). The mean hospital stay was 4.5 days (range, 3 – 6). Pathological evaluation revealed three mature cystic teratomas (torsed as well), two ovarian cysts (torsed), two leiomyomas, one theca-luteoma and one endometrioma. One patient had a spontaneous abortion on post operative day five. There were five vaginal term deliveries and three preterm cesarean deliveries. 
Conclusion:  Operative laparoscopy is safe and effective in the management of pelvic disease associated with intrauterine pregnancies in selected cases with less postoperative morbidity and shorter hospital stays than laparotomy.