At the Rabin Medical Centre, Beilinson Hospital, Israel, a woman suffering from severe intestinal inflammation secondary to Crohn’s disease underwent a life-saving minimally invasive robotic bowel resection in her 32nd week of pregnancy.
The complex surgery, which lasted many hours and involved dozens of medical staff, was completed successfully - enabling her to carry the pregnancy to term and give birth to a healthy baby girl.
Tzofiya Leibovich, a 23-year-old medical student, was diagnosed with Crohn’s disease in her teens but had been symptom-free until the late stage of her first pregnancy. At week 32, she was admitted to Rabin Medical Centre with severe abdominal and back pain. She was hospitalised in the Maternal-Fetal Unit, where doctors diagnosed acute intestinal inflammation. Despite medical treatment, the inflammation worsened, and a perforation developed in her intestine, putting her life in immediate danger and requiring urgent surgical intervention.
“The standard surgical approach for intestinal perforation during pregnancy is a full open abdominal surgery, terminating the pregnancy and delivering a premature baby,” explains Dr. Ian White, Director of the Colorectal Surgery Unit at Rabin Medical Center. “A laparoscopic-robotic procedure is extremely complex in such an advanced stage of pregnancy, because the enlarged uterus obscures the intestines and makes access nearly impossible."
Despite the risks, the team decided to attempt the laparoscopic-robotic surgery, aiming to preserve the pregnancy and avoid premature birth with all its respiratory and developmental complications. Together with Prof. Asnat Walfisch, Director of the Women’s Hospital, and Prof. Eran Hadar, Head of Maternal-Fetal Medicine, it was decided to proceed laparoscopically under full preparedness for an emergency cesarean if needed.
Because of the extraordinary complexity, the surgery lasted many tense hours and was performed in the women’s operating suite, with senior gynaecologists, neonatologists from Schneider Children’s Hospital, and continuous fetal monitoring present throughout.
"At every stage we debated whether to continue or convert to open surgery,” Dr. White recalls. “As long as both mother and fetus remained stable, we pressed on. The operation succeeded, her pain subsided, and she was out of danger. Since this procedure had never been attempted before, I was anxious until the baby was safely born at week 38."
Tzofiya (the patient) shares: “I didn’t want surgery. I didn’t want to deliver early, to be left with a large scar across my abdomen, and certainly not with a stoma. I was paralysed, unable to sleep, screaming from unbearable pain. I understood they would try laparoscopic surgery with very low chances of success, and most likely they’d have to open me up and deliver the baby. Dr. White, who is religious, came to the hospital on Shabbat - and that’s when I realised how extraordinary this moment truly was."
