Operative laparoscopy; is it a safe option in pregnancy?

We report a case of an ovarian cyst in pregnancy complicated by torsion of the cyst requiring urgent surgical intervention at 13 weeks of gestation. The case was successfully managed by laparoscopic ovarian cystectomy without any maternal or fetal complications. Thus proving that operative laparoscopy in pregnancy is a safe and feasible option. Approximately 0.2% of pregnant women require intra-abdominal general surgery during pregnancy. Benefits of laparoscopic surgery compared to the traditional open surgery are well recognised; notably, a shorter hospital stay and a reduced rate of post-operative complications. Pregnancy poses unique surgical and anaesthetic problems due to altered physiology and anatomy in pregnancy. The effect of the pneumoperitoneum on the maternal haemodynamic status, risk of uterine/fetal damage by trocar entry, risk of miscarriage and preterm labour are some serious concerns that may limit the feasibility and safety of operative laparoscopy in pregnancy. In the past few decades, there has been increasing evidence emerging in the medical literature supporting the safety of operative laparoscopy in pregnancy. The second trimester is considered to be the safest period in terms of least risk to the fetus and also seems more favourable for the technical aspect of the laparoscopic procedures. Hasson's method of laparoscopic entry technique is prudent to avoid possible uterine injury. Although absolute safety of laparoscopic surgery during pregnancy in humans is yet to be established, presently, operative laparoscopy by an experienced laparoscopist is considered a safe and effective alternative to traditional laparotomy. Prospective randomised controlled studies in this clinical territory are lacking.