From the Research
Port placement for laparoscopic cholecystectomy in a 32-week pregnant patient should be modified to accommodate the enlarged uterus, with the primary port placed using an open Hasson technique at the right upper quadrant or right subcostal region, approximately 3-5 cm above the fundus of the uterus. This approach is supported by the most recent study available, which highlights the importance of proper port placement and technique in achieving excellent outcomes in laparoscopic cholecystectomy during the third trimester of pregnancy 1. The key considerations for port placement in this context include:
- Placing the primary port under direct visualization to avoid uterine injury
- Positioning additional working ports higher than standard to accommodate the enlarged uterus
- Limiting insufflation pressure to 10-12 mmHg to minimize decreased venous return and potential fetal acidosis
- Positioning the patient in left lateral decubitus with a slight reverse Trendelenburg to displace the uterus away from the operative field
These modifications are crucial because the enlarged uterus at 32 weeks significantly alters the abdominal anatomy, increasing the risk of uterine injury with standard port placement techniques. The study by 1 demonstrates that with proper technique and port placement, laparoscopic cholecystectomy can be safely performed in the third trimester, emphasizing the importance of experience and adherence to guidelines such as those from SAGES.
The optimal port site placement should prioritize minimizing the risk of uterine injury and ensuring the safety of both the mother and the fetus, as emphasized in the guidelines and supported by the clinical experience reported in the literature 1, 2, 3, 4, 5. However, the most recent and highest quality study 1 provides the most relevant guidance for current practice, highlighting the feasibility and safety of laparoscopic cholecystectomy in the third trimester with appropriate modifications to technique and port placement.