Pregnancy: A contraindication?

According to David L. Sackett evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence when making decisions about the care of individual patients. It means integrating individual cli nical expertise with the best available external evidence from systematic r esearch. On the basis of this idea in medicine the following communication summarizes and evaluates current statements and literature on laparoscopic surgery during pregnancy. The topic is an example for excellent individual clinical performance on one hand, as gynecologists have perform laparoscopi c procedures during pregnancy for decades. On the other hand, pregnancy is considered to be a contraindication for laparoscopic surgery by clinicians, because no excellent external evidence from systematic research is availab le. To find an answer to the question of whether pregnancy is a contraindic ation for laparoscopic surgery we performed a literature search and gained information by conducting interviews with several experts in gynecology and endoscopic operations. We concluded that there are almost no "scientific" data about endoscopic surgery during pregnancy, but gynecologists represent ing the "real world" seem to have no fear of the procedure for their patien ts. Between the two extremes, performing laparoscopic operations during pre gnancy might be advantageous for maximal patient-friendly surgery, but cons idering pregnancy as a contraindication for the laparoscopic approach might be the safer treatment. The reader mag. decide that the subject on endosco pic surgery in pregnancy is still open.