Title: An Interdisciplinary Challenge- Growing Interest on Laparoscopic Surgery during Early & Advanced Stage of Pregnancy
Authors: Dr Arati Nayak, Dr Arata Kumar Swain, Dr Pradipta Kumar Patel, Dr Girija Sankar Patra
DOI: http://dx.doi.org/10.18535/jmscr/v4i7.39
Abstract
A literature search was performed using Medline and the search engine Google. Criteria for selection of literature were methods of analysis (statistical or non statistical), operative procedure (only universally accepted procedures were selected) and the institution where the study was done (Specialized institution for laparoscopic surgery).Approximately 1 in 500 to 1 in 635 women will require non-obstetrical abdominal surgery during their pregnancies (1.2).
The most common non-obstetrical surgical emergencies complicating pregnancy are acute appendicitis, cholecystitis, and intestinal obstruction (1). Laparoscopic surgery in the pregnant patient is not yet broadly accepted; concern has been for fetal wastage, effects of carbon dioxide (CO2) on the developing fetus, and long-term sequelae during childhood development. The anesthesiologist must be aware of the physiologic changes associated with pregnancy and the effects of positioning, and the consequences of CO2 pneumoperitoneum on the parturient and the fetus. Important factors in laparoscopic surgery – risk of aspiration, Supine hypertensive syndrome. Pneumoperitoneum during pregnancy results in more pronounced restrictive lung physiology. Avoid hypoxemia, hypotension, acidosis, hypoventilation, and hyperventilation. Anesthesiologists must maintain a high index of suspicion for complications such as gas embolism, extraperitoneal insufflations surgical emphysema, pneumothorax and pneumomediastinum. Invasive monitoring could be required in those patients with significant cardiovascular or pulmonary disease.Now a days Minimally invasive surgery is being performed more frequently in pregnant patients. Literatures suggest that Laparoscopic surgery during pregnancy is safe, has multiple advantages over open techniques and can be performed during all gestational ages.
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