This chapter summarizes current data on the maternal and fetal effects of nonobstetrical surgeries during pregnancy, including anesthesia, diagnostic and therapeutic management, laparoscopy, and the common general surgical pathologies found in the pregnant patient. Changes in maternal physiology during pregnancy due to gestational hormones and mechanical effects of the increasingly gravid uterus have an impact on anesthesia during nonobstetrical surgery. The American College for Obstetrics and Gynecology (ACOG) concluded that although there are no data to support specific recommendations for nonobstetrical surgery and anesthesia in pregnancy, it is important for physicians to obtain obstetric consultation before surgery. The fetal loss rate is significantly greater for pregnant patients undergoing appendectomy when compared to other surgical procedures during pregnancy. Laparoscopic management of adnexal masses in pregnancy is a safe and effective procedure compared to traditional surgery.

Transvaginal ultrasound examination is an excellent tool for solving clinical problems in women with symptoms suggesting the presence of adnexal mass. An experienced ultrasound examiner can confidently discriminate between benign and malignant pelvic tumours in the adnexal region using pattern recognition. Some tumours - for example, endometriomas, dermoid cysts, hydropyo- and haematosalpinx, peritoneal pseudocysts, paraovarian cysts, haemorrhagic corpus luteum cysts, myomas, abscesses and ovarian fibromas, thecomas and Brenner tumours - may present with typical appearances at greyscale imaging. Doppler assessment of intratumoral blood flow contributes little to the correct specific diagnosis of adnexal mass. The ability to make a correct specific diagnosis in a series of pelvic tumours is highly dependent upon the types of tumour in the tumour series studied. The surgical removal of the adnexal mass with benign ultrasound morphology is incidentally detected at ultrasound examination in asymptomatic women.

This chapter focuses on the use of laparoscopy in treatment and diagnosis of patients with pelvic pain, adnexal masses, and pelvic inflammatory disease (PID). A discussion of incidental appendectomy in these patients will also be presented. The decision to perform incidental appendectomy is based on the premise that the appendix is a vestigial, functionless organ, with the potential only to contribute to pathological change. PID can have devastating consequences to adolescent females. With the advent of in vitro fertilization, surgeons should attempt to perform the most conservative surgery that is safely possible, in order to maintain the option of future childbearing. Diagnosis of endometriosis should not be delayed in adolescents. A delay may not only postpone symptomatic relief but also worsen the patient's future fertility and allow the disease to progress. Laparoscopy, as it applies to the pediatric and adolescent population, is a relative newcomer to the field.