Case report: retroperitoneoscopic tumor nephrectomy during pregnancy.
When considering laparoscopic tumor nephrectomy during pregnancy, questions will arise about the consequences of the increased abdominal pressure (IAP) for uterine-placental perfusion and the impact of carbondioxide insufflation on the fetus. These considerations should be weighed against the advantages for the mother, in term of shorter convalescence and decreased wound problems. This situation presents the urologists with a dilemma. At 16 weeks of gestation, a 30-year-old woman underwent a retroperitoneoscopic tumor nephrectomy. This case report and the following discussion highlight the key issues involved in laparoscopic surgery during pregnancy. In theory, laparoscopy in pregnancy carries some specific hazards, which may influence fetal outcome. First, the elevation of IAP may lead to alterations in placental perfusion, and second, CO2 insufflation may disturb the acid-base balance. However, in a study covering more than 2 million pregnancies, no difference was found in fetal mortality or malformations after laparoscopic surgery for non-obstetric reasons compared with open surgery. Animal experiments have demonstrated an IAP of 15 mm Hg or less to cause almost no reduction in the uterine-placental blood flow. According to our limited experience and with the support of the literature, pneumo(retro)peritoneum during pregnancy seems to be safe.
Urological Clinic, Canisius-Wilhelmina Hospital, and University Medical Centre St. Radboud, Nijmegen, The Netherlands. J.v.Basten@cwz.nl
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van Basten
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Knipscheer
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de Kruif
D000328:Adult; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D009392:Nephrectomy / Q000379:methods*; D010298:Parity; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis / Q000601:surgery*; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First; D047929:Term Birth; D016896:Treatment Outcome