American Board of Internal Medicine (ABIM) Certification Practice Exam

In which trimester can laparoscopic cholecystectomy be safely performed during pregnancy?

1. First trimester

2. Second trimester

3. Third trimester

4. It should not be performed during pregnancy

The correct answer is: Second trimester

Laparoscopic cholecystectomy is often considered the safest during the second trimester of pregnancy. During this period, the risk of miscarriage is significantly lower compared to the first trimester, and the uterus has not yet grown to the size that might complicate surgical access or lead to increased pressure on the diaphragm and other abdominal organs, as seen in the third trimester. Additionally, the second trimester allows for better visualization and access due to less adipose tissue surrounding the area, which is advantageous for laparoscopic procedures. Furthermore, the physiological changes that occur during the second trimester, such as changes in blood volume and systemic vascular resistance, can be more favorable from an anesthetic perspective. In contrast, the first trimester poses a higher risk for complications related to miscarriage, and the third trimester can have complications associated with the enlarged uterus, such as increased pressure on major blood vessels and respiratory challenges during surgery. Thus, the second trimester is the optimal period for performing laparoscopic cholecystectomy in pregnant patients.