{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T01:13:57Z","timestamp":1790730837186,"version":"4.1.0"},"reference-count":32,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,11,13]],"date-time":"2021-11-13T00:00:00Z","timestamp":1636761600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>This paper reports a case of a 21 year old primigravida at 6 weeks gestation, suffering from important abdominal pain, who was admitted into the medical center with a giant cyst of 28 \u00d7 20 cm on her left ovary. A torsion of the ovarian cyst was suspected. Her COVID-19 status was unknown. In view of the emergency of the situation and the COVID-19 pandemic, laparoscopy in spinal anesthesia was performed. The patient remained conscious during the surgical intervention and tolerated it well apart from a slight dyspnea, which was easily eliminated by changing her body position and decreasing the pneumoperitoneum pressure. The ovarian cyst was removed by enlarging the trocar incision. The patient recovered with neither incident nor pregnancy loss. COVID-19-related complications can induce adverse pregnancy outcomes. Under general anesthesia, patients with COVID-19 are at risk of severe pneumonia and of passing their infection to the medical personnel. To avoid such complications in non-specialized centers, laparoscopy should be performed in regional anesthesia. Laparoscopy in spinal anesthesia can be performed safely on pregnant patients by placing them in the proper position, using a low pneumoperitoneum, and monitoring the hemodynamics. During early pregnancy, general anesthesia induces a higher risk of teratogenic effects and of miscarriage.<\/jats:p>","DOI":"10.3390\/medsci9040070","type":"journal-article","created":{"date-parts":[[2021,11,14]],"date-time":"2021-11-14T20:52:28Z","timestamp":1636923148000},"page":"70","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Removal of a Giant Cyst of the Left Ovary from a Pregnant Woman in the First Trimester by Laparoscopic Surgery under Spinal Anesthesia during the COVID-19 Pandemic"],"prefix":"10.3390","volume":"9","author":[{"given":"Attila Louis","family":"Major","sequence":"first","affiliation":[{"name":"Femina Gynecology Centre, CH-1205 Geneva, Switzerland"},{"name":"Department of Obstetrics & Gynecology, University of Fribourg, CH-1700 Fribourg, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kudrat","family":"Jumaniyazov","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Urgench Branch of Tashkent Medical Academy, Urgench 220100, Uzbekistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahnoza","family":"Yusupova","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Urgench Branch of Tashkent Medical Academy, Urgench 220100, Uzbekistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruslan","family":"Jabbarov","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Urgench Branch of Tashkent Medical Academy, Urgench 220100, Uzbekistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0046-5521","authenticated-orcid":false,"given":"Olimjon","family":"Saidmamatov","sequence":"additional","affiliation":[{"name":"Faculty of Tourism and Economics, Urgench State University, Urgench 220100, Uzbekistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivanna","family":"Mayboroda-Major","sequence":"additional","affiliation":[{"name":"Department of Gynecology & Obstetrics, University Hospital of Geneva, CH-1205 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,13]]},"reference":[{"key":"ref_1","unstructured":"Jumaniyazov, K., Ruslan, J., and Major, A. 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Anaesth."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1097\/AOG.0000000000002618","article-title":"Minimally Invasive Gynecologic Surgery: Case Report: Total Laparoscopic Hysterectomy under Regional Anesthesia","volume":"131","author":"Moawad","year":"2018","journal-title":"Obstet. Gynecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1111\/j.1399-6576.1994.tb03889.x","article-title":"Haemodynamic effects of pneumoperitoneum and the influence of posture during anaesthesia for laparoscopic surgery","volume":"38","author":"Odeberg","year":"1994","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1016\/j.jmig.2019.03.012","article-title":"Emergent Laparoscopic Removal of a Perforating Intrauterine Device during Pregnancy Under Regional Anesthesia","volume":"26","author":"Giampaolino","year":"2019","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1093\/bjaceaccp\/mkh032","article-title":"Laparoscopic Abdominal Surgery","volume":"4","author":"Perrin","year":"2004","journal-title":"Contin. Educ. Anaesth. Crit. Care Pain"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e74","DOI":"10.1016\/S0140-6736(20)32279-0","article-title":"Surgery during the COVID-19 Pandemic","volume":"396","author":"Harsha","year":"2020","journal-title":"Lancet"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1111\/anae.15105","article-title":"Neuraxial Anaesthesia and Peripheral Nerve Blocks during the COVID-19 Pandemic: A Literature Review and Practice Recommendations","volume":"75","author":"Uppal","year":"2020","journal-title":"Anaesthesia"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1177\/1553350620964323","article-title":"Adaptations and Safety Modifications to Perform Safe Minimal Access Surgery (Minimally Invasive Surgery: Laparoscopy and Robotic) during the COVID-19 Pandemic","volume":"28","author":"Somashekhar","year":"2020","journal-title":"Surg. Innov."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2327","DOI":"10.1007\/s00464-020-07565-w","article-title":"SAGES and EAES recommendations for minimally invasive surgery during COVID-19 pandemic","volume":"34","author":"Francis","year":"2020","journal-title":"Surg. Endosc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.jhin.2021.08.022","article-title":"Detection of human coronavirus RNA in surgical smoke generated by surgical devices","volume":"117","author":"Yokoe","year":"2021","journal-title":"J. Hosp. Infect."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2515","DOI":"10.18203\/2320-1770.ijrcog20182381","article-title":"A rare case of spontaneous heterotopic pregnancy with successful pregnancy outcome following laparoscopic management of coexisting ruptured tubal pregnancy in Non-ART set up","volume":"7","author":"Maiti","year":"2018","journal-title":"Int. J. Reprod. Contracept. Obstet. Gynecol."},{"key":"ref_13","first-page":"23","article-title":"Intrathecal opioids versus epidural local anesthetics for labor analgesia: A meta-analysis","volume":"27","author":"Bucklin","year":"2002","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1016\/j.neuropharm.2007.09.005","article-title":"Effects of fetal exposure to isoflurane on postnatal memory and learning in rats","volume":"53","author":"Li","year":"2007","journal-title":"Neuropharmacology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1097\/GRF.0b013e3181c11f60","article-title":"Anesthesia for nonobstetric surgery: Maternal and fetal considerations","volume":"52","author":"Cheek","year":"2009","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_16","first-page":"520","article-title":"Laparoscopic management of adnexal torsion","volume":"34","author":"Mage","year":"1989","journal-title":"J. Reprod. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1089\/lps.1991.1.161","article-title":"Laparoscopic ovarian cystectomy during pregnancy","volume":"1","author":"Nezhat","year":"1991","journal-title":"J. Laparoendosc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.ajog.2003.11.019","article-title":"Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome","volume":"191","author":"Wong","year":"2004","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.jmii.2018.04.005","article-title":"Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection during pregnancy: Report of two cases & review of the literature","volume":"52","author":"Alfaraj","year":"2019","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e25","DOI":"10.1213\/ANE.0000000000004840","article-title":"Lessons learned from first COVID-19 cases in the United States","volume":"131","author":"Landau","year":"2020","journal-title":"Anesth. Analg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.bja.2020.05.029","article-title":"Supporting more than one patient with a single mechanical ventilator: Useful last resort or unjustifiable risk?","volume":"125","author":"Laffey","year":"2020","journal-title":"Br. J. Anaesth."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.bja.2020.05.016","article-title":"Regional Anaesthesia and COVID-19: First Choice at Last?","volume":"125","author":"Macfarlane","year":"2020","journal-title":"Br. J. Anaesth."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.ejogrb.2013.04.012","article-title":"Gasless laparoscopic surgery during pregnancy: Evaluation of its role and usefulness","volume":"170","author":"Sesti","year":"2013","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.jcma.2013.04.008","article-title":"An 11-year experience with ovarian surgery during pregnancy","volume":"76","author":"Koo","year":"2013","journal-title":"J. Chin. Med. Assoc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1046\/j.1365-2508.1997.640475.x","article-title":"Gasless laparoscopy under epidural anaesthesia for adnexal surgery in pregnancy","volume":"6","author":"Pelosi","year":"1997","journal-title":"Gynaecol. Endosc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1046\/j.1365-2508.1998.00158.x","article-title":"Gasless laparoscopic ovarian cystectomy with minilaparotomy during pregnancy","volume":"7","author":"Inoue","year":"1998","journal-title":"Gynaecol. Endosc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1007\/s12262-020-02444-z","article-title":"Role of Regional Anaesthesia in Laparoscopy during COVID-19","volume":"82","author":"Bhattacharya","year":"2020","journal-title":"Indian J. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2185","DOI":"10.1007\/s00192-020-04463-6","article-title":"The Comeback of Vaginal Surgery during and after the COVID-19 Pandemic: A New Paradigm","volume":"31","author":"Chene","year":"2020","journal-title":"Int. Urogynecol. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e22","DOI":"10.1213\/ANE.0000000000004831","article-title":"Neuraxial procedures in COVID-19 positive parturients: A review of current reports","volume":"131","author":"Bauer","year":"2020","journal-title":"Anesth. Analg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.ijsu.2020.05.076","article-title":"COVID 19 and Laparoscopic Surgeons, the Indian Scenario\u2014Perspective","volume":"79","author":"Gupta","year":"2020","journal-title":"Int. J. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1007\/s12630-020-01637-0","article-title":"Practical Considerations for Performing Regional Anesthesia: Lessons Learned from the COVID-19 Pandemic","volume":"67","author":"Lie","year":"2020","journal-title":"Can. J. 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