Laparoscopic surgery for presumed benign ovarian tumor during pregnancy

No randomized controlled trials to compare 'open surgery' with 'keyhole surgery' in pregnant women for non-malignant tumors of the ovary.

A small number of women have tumors of the ovaries diagnosed during pregnancy. Most of these tumors are not malignant, and if they are small then treatment can be left until after the birth. However, if the tumour is larger that 6 cm in diameter, it is suggested that it is better to operate and remove them during pregnancy, as they may interfere with the birth of the baby. Surgical procedures for these non-malignant tumors of the ovary in pregnancy can be performed by open surgery (laparotomy) or keyhole surgery (laparoscopy) techniques. Historically, open surgery has been used, but new keyhole surgery seems attractive in that it appears to require a shorter hospital stay and there is a quicker return to normal activities for women. However, the infusion of gas into the abdomen during the key-hole procedure may have adverse effects on the baby, and an additional gasless technique is also under study. This review aimed to address the question of which surgical technique might be better as all have benefits and risks to the mother and the baby. There were no randomized controlled trials identified that compared the effects of using keyhole surgery for benign tumors of the ovary during pregnancy on maternal and fetal health. There was some evidence available from case series studies, but more research is needed on the potential benefits and harms associated with this new surgical technique in pregnancy.

Authors' conclusions: 

The practice of laparoscopic surgery for benign ovarian tumour during pregnancy is associated with benefits and harms. However, the evidence for the magnitude of these benefits and harms is drawn from case series studies, associated with potential bias. The results and conclusions of these studies must therefore be interpreted with caution.

The available case series studies of laparoscopic surgery for benign ovarian tumour during pregnancy provide limited insight into the potential benefits and harms associated with this new surgical technique in pregnancy. Randomized controlled trials are required to provide the most reliable evidence regarding the benefits and harms of laparoscopic surgery for benign ovarian tumour during pregnancy.

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Background: 

The surgical management of ovarian tumors in pregnancy is similar to that of non-pregnant women. The procedures include resection of the tumor (enucleation), removal of an ovary or ovaries (oophorectomy), or surgical excision of the fallopian tube and ovary (salpingo-oophorectomy). The procedure can be done by open surgery (laparotomy) or keyhole surgery (laparoscopy) technique. The benefits of laparoscopic surgery include shorter hospital stay, earlier return to normal activity, and reduced postoperative pain. However, conventional laparoscopic surgery techniques required the infusion of gas carbon dioxide in the peritoneum to distend the abdomen and displace the bowel upward to create the room for surgical manipulation. Serious complications such as abnormally high levels of carbon dioxide in the circulating blood (hypercarbia) and perforation of internal organs have also been reported. These serious complication may be harmful to the fetus.

Objectives: 

To compare the effects of using laparoscopic surgery for benign ovarian tumor during pregnancy on maternal and fetal health and the use of healthcare resources.

Search strategy: 

We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 11 November 2012.

Selection criteria: 

Randomized controlled trials with reported data that compared outcomes of laparoscopic surgery for benign ovarian tumor in pregnancy to conventional laparotomy technique.

Data collection and analysis: 

Two review authors planned to independently assess trial quality and extract data.

Main results: 

The updated search did not identify any randomized controlled trials.

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