Laparoscopic Treatment of Benign Adnexal Masses During Pregnancy: A Comprehensive Evaluation of Treatment Basics, Efficacy and Surgical Techniques

This review summarizes the evidence-based recommendations for how to approach and laparoscopically treat adnexal masses during pregnancy. We conducted a comprehensive review of studies related to the laparoscopic management of adnexal masses during pregnancy. Selected studies were independently reviewed by two authors. The overall incidence of ovarian tumors in pregnancy ranges between 0.05% and 5.7%, of which less than 5% are malignant. Diagnosis is based mainly on routine transvaginal ultrasound. More than 64% of simple cysts, less than 6 cm in diameter, will spontaneously resolve in less than 16 weeks. However, for persistent and complex tumors, the risk of acute complications can reach up to 9%. Surgical indications are similar to those in the non-gravidic setting, and include acute complications (torsion, rupture, hemorrhage), suspected malignancy and large (over 6 cm) persistent masses. Surgery must be scheduled between 16 and 20 weeks to allow for the spontaneous resolution of functional cysts. Furthermore, within that period, pregnancy becomes independent of the corpus luteum and enlargement of the uterus gives sufficient exposure for the surgery to be performed safely. A recent meta-analysis found that, compared to open surgery, laparoscopy is associated with significantly less preterm labor, blood loss and hospital stay, without differences in pregnancy loss or preterm birth rate. Since the main concerns about maternal-fetal safety are related to increased intraperitoneal pressure and the effects of hypercarbia (maternal hypertensive complications, fetal acidosis), a lower CO2 pressure (10 to 12 mmHg) and reduced operative times (less than 30 minutes) are recommended.