Design: A retrospective cohort study between April 2011 and March 2020.

Setting: A single tertiary affiliated medical center.

Patients or Participants: All patients who underwent laparoscopic abdominal surgery during pregnancy and delivered at our hospital were included, 191 pateints were included.

Interventions: Laparoscopic abdominal surgery.

Measurements and Main Results: A total of 191 women underwent laparoscopic surgery during pregnancy: 95 (50%), 82 (43%) and 14 (7%) at first, second and third trimester respectively. Baseline characteristics and obstetric history were comparable between groups. More patients underwent adnexal surgery at first and third trimester compared to mid trimester (62.1%, 50% and 41.5% respectively; p=0.02). There was increasing trend of using Hasson entry technique at second and third trimesters compared to first trimester (55.3%, 72.7% and 5.9% respectively; p<0.001). Conversion to laparotomy and post operative ileus rates were higher at third trimester, however rates of other intraoperative and postoperative complications were comparable. Pregnancy and neonatal outcomes were also comparable. Rate of preterm labor (PTL) was 15.7%, in multivariate regression analysis multifetal pregnancy (aOR 95% CI 16.6, 4.97-55.69) and adnexal surgery (aOR 95% CI 0.31 ,0.12-0.79) were independently associated with PTL.

Conclusion: Laparoscopic abdominal surgery during pregnancy is feasible and relatively safe regardless of pregnancy trimester. Hasson technique was more used during third trimester compared to first and second trimesters, and rates of conversion to laparotomy and post operative ileus were higher at third trimester compared to first and second trimesters. However, pregnancy outcomes following surgery were comparable between the three trimesters.