Since the advent of laparoscopic surgery in the 1980s, laparoscopic surgery has been popularized by surgeons throughout the world. However, routine laparoscopic surgery has been slow to catch on in one group of patients, that is, the pregnant patient. The responsibility of caring for two patients during one operation and the concern over potential harm to the unborn fetus due to the pneumoperitoneum and/or instrumentation are factors that have played a role in the delay of adapting laparoscopic surgery to the pregnant patient. However, recent evidence suggests that not only is laparoscopic surgery safe in the pregnant patient in all three trimesters, but it is also often preferable.

This chapter reviews several aspects of laparoscopic surgery in the pregnant patient.

PHYSIOLOGIC CHANGES OF PREGNANCY

One must consider the many physiologic changes that occur during pregnancy when discussing any surgery in a pregnant patient. From a respiratory standpoint, the minute ventilation is 50% higher than normal, resulting in a marked decrease in arterial concentration of carbon dioxide, and mild respiratory alkalosis. In contrast, the fetus has a normal mild respiratory acidosis, which is thought to facilitate delivery of oxygen. It has also been shown that the normal pregnant patient has a mild anemia, increased cardiac output, increased heart rate, and an increased oxygen consumption to support two circulatory systems and provide adequate oxygenation to both the mother and fetus.