Clinical Challenges in Minimally Invasive Surgery: MIS in the Pregnant Patient

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 16 November 2023

⏱️ 41 minutes

🔗️ Recording | iTunes | RSS

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Summary

If you operate for long enough, chances are you will come across the unique, and potentially daunting scenario of operating on a pregnant patient. If, and when, you do, would you know what to do? Join University of Washington and MIS faculty Drs. Andrew Wright, Nicole White, and Nick Cetrulo, and residents Drs. Ben Vierra and Paul Herman as they discuss non-obstetric surgery in the pregnant patient so that you will be better informed when the challenge arises.

Hosts:
1. Andrew Wright, UW Medical Center—Montlake and Northwest, @andrewswright
2. Nick Cetrulo, UW Medical Center—Northwest, @Trules25
3. Nicole White, UW Medical Center—Northwest, @NicoleWhiteTho1
4. Paul Herman, UW General Surgery Resident PGY-3, @paul_herm
5. Ben Vierra, UW General Surgery Resident PGY-2

Learning Objectives
1. Describe important physiologic changes in pregnancy that are relevant for the surgeon to know.
2. Review the epidemiology of non-obstetric general surgery in the pregnant patient.
3. Discuss specific imaging considerations in the pregnant patient.
4. Become more familiar with the technical aspects of approaching a typical surgical case in a pregnant patient.

References
1. Pearl, J.P., Price, R.R., Tonkin, A.E. et al. SAGES guidelines for the use of laparoscopy during pregnancy. Surg Endosc 31, 3767–3782 (2017). https://doi.org/10.1007/s00464-017-5637-3
2. Vasileiou G, Eid AI, Qian S, Pust GD, Rattan R, Namias N, Larentzakis A, Kaafarani HMA, Yeh DD; EAST Appendicitis Study Group. Appendicitis in Pregnancy: A Post-Hoc Analysis of an EAST Multicenter Study. Surg Infect (Larchmt). 2020 Apr;21(3):205-211. https://pubmed.ncbi.nlm.nih.gov/31687887/
3. Dongarwar D, Taylor J, Ajewole V, Anene N, Omoyele O, Ogba C, Oluwatoba A, Giger D, Thuy A, Argueta E, Naik E, Salemi JL, Spooner K, Olaleye O, Salihu HM. Trends in Appendicitis Among Pregnant Women, the Risk for Cardiac Arrest, and Maternal-Fetal Mortality. World J Surg. 2020 Dec;44(12):3999-4005. https://pubmed.ncbi.nlm.nih.gov/32737556/
4. Fong ZV, Pitt HA, Strasberg SM, Molina RL, Perez NP, Kelleher CM, Loehrer AP, Sicklick JK, Talamini MA, Lillemoe KD, Chang DC; California Cholecystectomy Group. Cholecystectomy During the Third Trimester of Pregnancy: Proceed or Delay? J Am Coll Surg. 2019 Apr;228(4):494-502.e1. https://pubmed.ncbi.nlm.nih.gov/30769111/
5. Hong J, Yang J, Zhang X, Su J, Tumati A, Garry D, Docimo S, Bates AT, Spaniolas K, Talamini MA, Pryor AD. Considering delay of cholecystectomy in the third trimester of pregnancy. Surg Endosc. 2021 Aug;35(8):4673-4680. https://pubmed.ncbi.nlm.nih.gov/32875420/
6. ACOG Committee Opinion No. 775: Nonobstetric Surgery During Pregnancy. Obstet Gynecol. 2019 Apr;133(4):e285-e286. https://pubmed.ncbi.nlm.nih.gov/30913200/
7. Ashbrook M, Cheng V, Sandhu K, Matsuo K, Schellenberg M, Inaba K, Matsushima K. Management of Complicated Appendicitis During Pregnancy in the US. JAMA Netw Open. 2022 Apr 1;5(4):e227555. https://pubmed.ncbi.nlm.nih.gov/35426921/
8. Capella CE, Godovchik J, Chandrasekar T, Al-Kouatly HB. Nonobstetrical Robotic-Assisted Laparoscopic Surgery in Pregnancy: A Systematic Literature Review. Urology. 2021 May;151:58-66. https://pubmed.ncbi.nlm.nih.gov/32445766/

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Transcript

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0:00.0	Behind the surgery podcast, relevant and engaging content designed to help you dominate the day. Ladies and gentlemen, I am thrilled to introduce the third edition of the Behind the
0:30.0	Knife Absight Podcast Companion. This latest version offers enhanced images with
0:36.1	immersive audio content for each section making it an unparalleled educational
0:41.1	resource. We've expanded our content with new chapters covering topics like
0:46.0	MIS, oncology, Ooby-G-Y-N, urology, and more. You can find the book in both print and e-book formats on Amazon.
0:56.2	Get ready to elevate your knowledge and achieve top absight scores with the all new behind
1:00.8	the knife absight podcast companion, an indispensable partner on your path to surgical
1:05.8	excellence. Good luck on the upcoming Appsight exam and dominate the day.
1:11.1	Hello everyone, welcome to another episode of Behind the Knife. My name is Ben Vieira. I'll be our host today as we continue our series in minimally evasive surgery.
1:19.0	For brief introductions, I'm a current general surgery resident at University of Washington.
1:24.0	Here at the me is Paul Herman, another resident at University of Washington, as well as several of our
1:28.8	MIS faculty, Dr White, Dr. Wright, and Dr. Strillo.
1:33.0	Today for a segment on clinical challenges in minimally invasive surgery,
1:37.0	we're excited to be discussing minimally invasive surgery
1:40.0	in a pregnant patient, a guide to how to approach the OR tips and tricks for technical success.
1:46.8	To begin, we'd like to first give a shout out to two excellent prior BTK episodes from 2021 focused on non-nostatric surgery in the pregnant patient.
1:57.0	They are titled Clinical Challenges in Trauma Surgery, the Pregnant Trauma Patient, and Journal Review
2:02.2	and Emergency General Surgery, Colestitis and pregnancy.
2:05.0	These will provide some background for our discussion today.
2:09.0	So that first episode, the one regarding trauma
2:12.0	in pregnant patients
2:13.1	provided a really good review of the physiologic changes associated with pregnancy
	...

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