6 Apart from the well-documented advantages of laparoscopic surgery over open surgery shared by pregnant and nonpregnant patients, additional benefits in pregnant patients include less respiratory depression because of reduced postoperative narcotics requirements, the lower risk of wound complications such Inhibitors,research,lifescience,medical as incisional hernia, decreased risks of thromboembolic events due to early mobilization, and diminished postoperative maternal hypoventilation.7 Moreover, with improved visualization,
laparoscopy reduces the risk of uterine irritability by decreasing the need for uterine manipulation and thus results in lower rates of spontaneous abortion and preterm delivery than open surgery.6 Certain limitations of laparoscopy during pregnancy have been highlighted, including fetal acidosis secondary to CO2 absorption, decreased uterine blood flow and alteration in placental perfusion secondary to pneumoperitoneum, fetal hypotension resulting from low maternal cardiac output, and injury Inhibitors,research,lifescience,medical to the www.selleckchem.com/products/at13387.html gravid uterus.6–8 In the absence of definitive evidence (Level I/Grade
A evidence) to date, many surgeons believe that pregnancy may be a contraindication to laparoscopy.5 However, experience with cholecystectomy, appendectomy (Level II/Grade B evidence), and adrenalectomy Inhibitors,research,lifescience,medical (Level III/Grade C evidence) suggests that such laparoscopic nonobstetric surgeries in pregnant patients can be safely Inhibitors,research,lifescience,medical done when standard precautions are taken.6,9–11 In a study by Reedy and colleagues,12 no differences were seen in fetal malformations or survival after laparoscopic (n = 2181) or open (n = 1522) abdominal nonobstetric surgeries during pregnancy. In another study, Holthausen and associates13 reviewed 112 laparoscopic
nonobstetric procedures during pregnancy, and found that the outcome of the mother and the baby delivered was excellent. At present, Inhibitors,research,lifescience,medical the experience of pure laparoscopic nephrectomy during pregnancy comprises only six cases performed to date (Table 1). Indication for operation was renal cell carcinoma (RCC) in five cases.5,14–17 In one case, retroperitoneoscopic nephrectomy was performed for giant hydronephrosis in a patient PAK6 at 9 weeks of gestation.2 Recently, a case of successful robot-assisted laparoscopic partial nephrectomy for RCC has been reported from South Korea (Table 1).18 Our case is the first case of pure transperitoneal laparoscopic nephrectomy performed for pyonephrotic nonfunctioning kidney during pregnancy. Table 1 Reported Cases of Laparoscopic Nephrectomy During Pregnancy Six of these reported procedures were performed during the second trimester and the remaining two during the first trimester.