H Abduljabar

Abdominal Wall Bowel Adhesions Resection Using CO2 Laser

A 22-year-old G1P0 underwent a laparoscopic ovarian cystectomy at 21 weeks for a persistent complex 8cm left ovarian cyst that became symptomatic for intermittent torsion. This video presentation reviews surgical risks and adaptations for safe laparoscopy to accommodate a second trimester pregnancy. Laparoscopy can be the primary option if there are concerns for ovarian torsion, rupture or cancer. Optimal timing is in the early 2nd trimester. Patients should be placed in the left lateral recumbent position to minimize uterine compression of the vena cava and aorta from the gravid uterus. Intraabdominal pressure is recommended to remain between 10-15mmHg to avoid a decrease in placental blood flow, potentially causing fetal hypoxia and fetal acidosis. The primary port can be placed at Palmer’s Point with other ports more superior than traditional locations. An endocatch bag can be placed through the umbilicus without the trocar.