Minimally invasive surgeries on pregnant patients have been performed for decades in Israeli medical centers, but methods have been developed over the years that allow surgery on women in the later stages of pregnancy.
Sheba Medical Center has operated the Israeli Training Endoscopic Center for the last few years where, with the collaboration of MSR, and the Israel Center for Medical Simulation, surgeons and gynecologists are trained to perform different types of laparoscopic surgeries, including those on pregnant women.
A High Level of Technical Skill
“When the embryo develops, the uterus grows and makes it difficult to enter the abdomen and reach the internal organs without causing injury to the uterus and the fetus,” explains Prof. Motti Goldenberg, head of the Gynecological Department and head of the Gynecological Surgery Day Clinic.
“Laparoscopic surgery in these cases requires the highest level of technical skill. Also, the abdominal space is taken up by intestinal loops. Everyone has nine meters of bowel which are pushed upwards during pregnancy, making it more difficult to access the organs.”
As with every laparoscopic surgery, the abdomen must be inflated using CO2 to provide the surgeon with a better view of the internal organs so they may more easily navigate within the body. Surgical instruments are introduced through three to four small incisions of up to 5 mm in length. These incisions do not leave significant scars.
The woman’s blood pressure is monitored during the entire procedure to ensure her and her fetus’s well-being. “An open surgery during pregnancy can cause a significant amount of suffering to the patient due to a large, painful scar and more difficult healing. Additionally, open surgery requires a vertical incision instead of a horizontal one, which makes healing slower and more difficult.
The abdomen continues to grow due to the pregnancy and the skin stretches which prevents the scar from healing normally and leads to less than satisfactory results cosmetically and aesthetically,” explains Prof. Goldenberg. “Laparoscopic surgery prevents this from happening.”
Studies show that laparoscopic surgeries performed during pregnancy do not speed up labor and do not increase the risk of pregnancy complications, premature birth, and congenital defects.
Furthermore, laparoscopic surgeries reduce the risk of common operative complications, such as infections and bleeding, and allow for a quicker recovery and release from the hospital compared to traditional open surgeries. “The pregnant patient stays for two days of monitoring after the surgery and then returns home,” explains Prof. Goldenberg.
Laparoscopic surgery at Sheba presents an opportunity for pregnant patients to receive a needed operation with minimal risk, discomfort, and scarring.