Pregnancy: A contraindication?
According to David L. Sackett evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence when making decisions about the care of individual patients. It means integrating individual clinical expertise with the best available external evidence from systematic research. On the basis of this idea in medicine the following communication summarizes and evaluates current statements and literature on laparoscopic surgery during pregnancy. The topic is an example for excellent individual clinical performance on one hand, as gynecologists have perform laparoscopic procedures during pregnancy for decades. On the other hand, pregnancy is considered to be a contraindication for laparoscopic surgery by clinicians, because no excellent external evidence from systematic research is available. To find an answer to the question of whether pregnancy is a contraindication for laparoscopic surgery we performed a literature search and gained information by conducting interviews with several experts in gynecology and endoscopic operations. We concluded that there are almost no "scientific" data about endoscopic surgery during pregnancy, but gynecologists representing the "real world" seem to have no fear of the procedure for their patients. Between the two extremes, performing laparoscopic operations during pregnancy might be advantageous for maximal patient-friendly surgery, but considering pregnancy as a contraindication for the laparoscopic approach might be the safer treatment. The reader may decide that the subject on endoscopic surgery in pregnancy is still open.
2nd Department of Surgery, University of Cologne, Ostmerheimerstrasse 200, 51109 Cologne, Germany.
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D001062:Appendectomy; D001064:Appendicitis / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000601:surgery*; D000075202:Contraindications; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D010535:Laparoscopy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery*; D012307:Risk Factors