Isobaric (gasless) laparoscopic myomectomy during pregnancy.

We report on the first case of an isobaric (gasless) laparoscopic myomectomy during the second trimester of pregnancy. Our patient had acute abdominal pain that did not respond to medical management. The procedure was performed under spinal anesthesia with conscious sedation. The remainder of the pregnancy was unremarkable. We believe that surgical management of uterine leiomyoma during pregnancy may be successfully performed in carefully selected patients. Laparotomy can be avoided, and pregnant patients can be managed safely by operative laparoscopy. With isobaric laparoscopy, the adverse effects and potential risks of CO2 insufflation are eliminated. The procedure can be performed under loco-regional anesthesia. The uterine closure can be performed safely and quickly as in laparotomy.