Laparoscopic Cornual Resection of Interstitial Ectopic Pregnancy

Abstract

Background:

An interstitial ectopic pregnancy implants within the proximal and intramural portion of the fallopian tube that is enveloped by the myometrium. The high mortality rate in this type of pregnancy is due, in part, to delay in diagnosis, as well as from massive intraperitoneal hemorrhage. Excessive blood loss can occur after a rupture or during surgical treatment of an interstitial pregnancy. Several ways to reduce surgical blood loss have been reported. Our team's experiences and management tools are described in this article and in a video (Supplementary Video S1; Supplementary data are available online at www.liebertonline.com/GYN) Both show a laparoscopic approach for managing an interstitial ectopic pregnancy to reduce the risk of uterine rupture and to preserve future fertility. To minimize surgical blood loss, both uterine arteries are temporarily occluded with surgical clips.

Technique:

Laparoscopic cornual resection of a left interstitial ectopic pregnancy involves: (1) successfully identifying the ureters and uterine arteries, and occluding the latter by surgical clipping; (2) making a circular incision in the left horn up to the gestational sac; (3) removing the cornual capsule and ipsilateral fallopian tube; (4) enucleating the entire gestational sac; and (5) suturing the myometrial bed and repairing the incision.

Conclusions:

Laparoscopic cornual resection is appropriate for interstitial pregnancy in patients wishing to preserve fertility. Temporary occlusion of bilateral uterine arteries using surgical clips is a safe, effective, blood-sparing intraoperative technique. (J GYNECOL SURG 39:82)