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Question 3#

Which of the following are true regarding safe laparoscopic surgery in pregnancy?

a. The patient should be position in the left lateral position
b. Open abdominal access (Hasson) is recommended versus direct puncture laparoscopy (Veress neelde)
c. The surgery should be performed during the second trimester if possible
d. All of the above

Correct Answer is D


Concerns about the safety of laparoscopic cholecystectomy and appendectomy in the pregnant patient have been thoroughly investigated and readily managed. Access to the abdomen in the pregnant patient should take into consideration the height of the uterine fundus, which reaches the umbilicus at 20 weeks. In order not to damage the uterus or tis blood supply, most surgeons feel that the open (Hasson) approach should be used in favor of direct puncture laparoscopy. The patient should be positioned slightly on the left side to avoid compression of the vena cava by the uterus. Because the pregnancy poses a risk for thromboembolism, sequential compression devices are essential for all procedures. Surgery should be performed in the second trimester, if possible. Protection of the fetus against intraoperative X-rays is imperative.