25/08/2026
🥇 My most challenging ovarian mass in pregnancy so far — probably my “TOP 1” in size and difficulty.
May mga cases na challenging dahil sa diagnosis. May mga cases naman na challenging dahil sa condition ng patient. Pero may mga cases na lahat ng factors kailangang pag-isipan at paghandaan nang mabuti.
This was one of those cases.
A 14-week pregnant patient with bilateral ovarian masses — ibig sabihin, parehong ovaries may cysts.
🔸 One ovarian mass measured approximately 10 cm
🔸 The other was almost 15x18 cm
🔸 Both were multiloculated dermoid cysts
That is a LOT of ovarian pathology to manage in a pregnant patient.
At hindi lang naman basta “tanggalin ang cyst” ang challenge.
We had to carefully consider WHEN to operate, HOW to operate, and HOW to minimize the risks to both mother and pregnancy.
Kailangan pag-isipan ang timing ng surgery versus the risks of leaving very large ovarian masses during pregnancy, including torsion, rupture, pain, obstruction, and the possibility of needing emergency surgery later on.
Mas naging challenging pa dahil may asthma at nagkaroon ng upper respiratory tract infection ang patient, so anesthesia and respiratory considerations also had to be taken very seriously.
Then came the surgical planning itself:
📍 Saan safest ilagay ang first trocar kapag lumalaki na ang uterus?
📍 Paano tayo makakapasok sa abdomen without injuring the uterus or the ovarian masses?
📍 Paano natin mamamanipulate nang safely ang ovaries na ganito kalalaki?
📍 Paano maiiwasan ang spillage mula sa dermoid cyst?
📍 Paano mapoprotektahan ang remaining normal ovarian tissue?
📍 At paano mapapanatili ang maternal physiologic stability — which is ultimately important for the pregnancy as well?
These are the things patients don't always see behind a “laparoscopic surgery.”
And this is why laparoscopy during pregnancy is not simply ordinary laparoscopy.
Kailangan ng very careful preoperative assessment, proper timing, pregnancy-specific trocar placement, attention to positioning and respiratory physiology, controlled pneumoperitoneum, and close coordination between the surgical, obstetric and anesthesia teams.
💛 But here's something I want pregnant patients to know:
Being pregnant does NOT automatically mean that laparoscopic surgery is unsafe. Current evidence and guidelines support performing laparoscopy during pregnancy when surgery is medically indicated, including for adnexal masses.
For pregnant patients, the surgical approach simply has to be adapted.
✔️ Abdominal entry and trocar placement are adjusted according to the uterine size and fundal height.
✔️ Positioning is modified to minimize aortocaval compression.
✔️ CO₂ insufflation is carefully controlled according to maternal physiology.
✔️ Appropriate maternal and anesthetic monitoring is essential.
✔️ Thromboembolism prevention is considered.
✔️ Fetal assessment is incorporated appropriately into perioperative care.
And most importantly, the decision to operate is individualized.
Hindi lahat ng ovarian cyst during pregnancy kailangan operahan.
But when surgery becomes necessary, the goal is not simply to remove the cyst. The goal is to address the surgical problem while protecting the mother, preserving ovarian tissue whenever possible, and giving the pregnancy the best possible chance to continue safely.
Two ovaries. Two giant dermoid cysts. One growing pregnancy. And very little room for error.
It's about careful planning, anticipating complications, knowing the anatomy, adapting the technique, and making the safest possible decision for the patient and her baby.
💛 Pregnancy may change the way we operate, but it does not necessarily take minimally invasive surgery off the table.
For pregnant patients with ovarian masses, don't panic. Get properly assessed and counseled by an experienced gynecologic surgeon and a multidisciplinary team. Every case is different, and the safest plan is always the one tailored to the mother and the pregnancy.
🏥 Ortigas Hospital and Healthcare Center
Attending OBGYN/OB Sonologist: Dr Mary Faith Angat
Minimally Invasive Gyne Surgeon: Jane Ellise Javier, MD
Minimally Invasive Gyne Assist: Dr Melissa Enriquez
Anesthesiologist: Dr Jenyvieve Bongat
