A case report of a laparoscopic nephrectomy for renal cell carcinoma in a pregnant woman: Clinical evaluation of the utero-fetal circulation during the laparoscopic procedure.

Abstract

  Renal cell carcinoma during pregnancy has rarely been reported in the literature. We report a case of a 34 year-old pregnant woman who underwent a laparoscopic nephrectomy for renal cell carcinoma at 15 weeks of gestation. Clinical symptoms included lower abdominal pain at 12 weeks of gestation. The UST, MRI and CT scan findings revealed a 7.6-cm tumor originating from the left kidney that was highly suspicious for malignancy. Further examinations suggested neither invasion nor metastasis to other organs, including the left renal vein and bones. Following an explanation of the above results, the patient and her family wished to continue the pregnancy. After obtaining informed consent, a laparoscopic nephrectomy was performed at 15 weeks of gestation under CO₂ pneumoperitoneum. The insufflated pressure was changed from 5mmHg to 12mmHg depending on the surgical process. The patient was lying in the right lateral position. The operation time was 5 hours and 15 minutes and the estimated blood loss was 50 ml. No operative complications were encountered during the procedure. The post-operative pathological diagnosis was clear cell carcinoma. During the operation, we examined the blood flow of the uterine arteries and the umbilical artery under pneumoperitoneum. The resistance index (RI) of the right uterine artery only correlated with the pressure of the pneumoperitoneum. A significant difference between the RIs of the both uterine arteries was observed. It was suggested that the difference of the RI resulted from the pressure of pneumoperitoneum and the body position during the operation. From our observations, we recommend that when performing laparoscopic surgery during pregnancy, the pressure of pneumoperitoneum should be kept under 12 mmHg and the body should be positioned to maintain adequate blood flow for both uterine arteries.