title: Meta-analysis comparing the safety of laparoscopic and open surgical approaches for suspected adnexal mass during the second trimester.
abstract: BACKGROUND
  The safety of laparoscopic surgery during the second trimester of pregnancy remains a controversial subject.
  
  
  OBJECTIVE
  To compare the safety of laparoscopic surgery and laparotomy for suspected adnexal mass during the second trimester.
  
  
  METHODS
  Articles published in any language prior to April 31, 2016, were retrieved from PubMed, Scopus, EMBSCO, and the Cochrane Library using keywords including pregnant, adnexal mass, laparoscopy, laparotomy, pregnancy outcomes, and surgical outcomes.
  
  
  METHODS
  Randomized and non-randomized controlled trials reporting at least one obstetric or surgical outcome were included if they compared laparoscopic surgery and laparotomy for adnexal masses during the second trimester.
  
  
  METHODS
  Data were independently extracted by two reviewers. Homogeneous data were pooled using a fixed effects model and heterogeneous data were qualitatively analyzed.
  
  
  RESULTS
  Four comparative effectiveness studies including a total of 240 patients were identified. Laparoscopic surgery was associated with a reduced risk of post-operative adverse events (relative risk 0.20, 95% confidence interval 0.06-0.72); no difference was recorded in the risk of post-operative spontaneous abortion (P=0.26) or threatened spontaneous abortion (P=0.13).
  
  
  CONCLUSIONS
  Laparoscopic surgery could be preferable to laparotomy for suspected adnexal mass during the second trimester of pregnancy.
authors.affiliation: Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
authors.forename: Yi-Xuan
authors.initials: YX
authors.lastname: Liu
authors.affiliation: Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.|Department of Obstetrics and Gynecology, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
authors.forename: Jin-Feng
authors.initials: JF
authors.lastname: Huang
authors.affiliation: Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.|Department of Obstetrics and Gynecology, Shanghai Medical College, Fudan University, Shanghai, China.|Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology* / Q000209:etiology; D000291:Adnexal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods*; D065228:Non-Randomized Controlled Trials as Topic; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D016032:Randomized Controlled Trials as Topic; D014463:Ultrasonography
keywords: Adnexal mass; Laparoscopy; Laparotomy; Meta-analysis; Pregnancy; Systematic review