Single Incision Laparoscopic Surgery in Pregnancy
Ismail A. Al-Badawi, MD, Hanan Alshankiti, MD, Sarfraz Ahmad, PhD
King Faisal Specialist Hospital and Research Center, Department of Obstetrics and Gynecology, Riyadh, Saudi Arabia (Drs Al-Badawi and Alshankiti). Florida Hospital Cancer Institute, Department of Gynecologic Oncology, Orlando, FL, USA (Dr Ahmad).
Laparoendoscopic single-site surgery, also known as single incision laparoscopic surgery (SILS), is advancing the minimally invasive surgical approach. Herein, we describe our experience with 2 cases using the SILS in pregnancy and discussing the relevant peer-reviewed English literature.
Case 1: A 42-year-old woman, who was pregnant at 17-weeks gestational age, presented with sudden onset right lower abdominal pain. Pelvic ultrasonogram characteristic revealed right large adnexal cyst measuring 12cm X 12 cm X 7 cm with torsion. Diagnosis of ovarian cyst with torsion was made, which indicated surgical intervention during pregnancy. SILS was performed using a single port through a 2-cm umbilical incision to the peritoneal cavity. Right ovarian cyst with torsion was identified. Untwisting of the torted pedicle and ovarian cystectomy was performed, the patient had a spontaneous vaginal delivery at 38 weeks.
Case 2: A 27-year-old woman, 12 weeks pregnant, presented through the emergency department with severe pain, and a pelvic ultrasonogram showed a 10-cm left adnexal mass with suspicion of torsion. Emergency diagnostic laparoscopy was performed using SILS with the finding of torted left ovarian cyst. Ovarian cystectomy and untwisting of the adnexa was performed, the patient had a preterm delivery of a stillborn at 20 weeks plus 4 days. We conclude with our successful experiences of SILS in pregnancy without any complications. This report is among the early experiences using SILS in pregnancy and is likely be the first from the Arab world (Middle East) experience. Further studies would be desirable to determine short-term and long-term outcomes.
Key Words: Case reports, Gynecologic surgery, Laparoscopy, Pregnancy, Single incision.