1173 A Surgical Technique for the Laparoscopic Intact Enucleation of an Interstitial Ectopic Pregnancy and Unilateral Selective Devascularization of the Uterus

Abstract

Video Objective To describe a step by step surgical technique for the laparoscopic intact enucleation of an interstitial ectopic pregnancy and unilateral selective devascularization of the uterus. Setting Interstitial ectopic pregnancy accounts for 2% to 4% of all ectopic pregnancies. Initial inaccurate diagnosis can occur in 40% of cases. The laparoscopic cornual resection or cornuotomy is becoming more commonly used procedure. However, laparoscopic procedure may need to be converted to laparotomy due to bleeding and or adhesions in up to 5.4% of cases. In addition, the incidence of persistent interstitial ectopic pregnancy after laparoscopic cornual resection or cornuotomy can be as high as 7% to 8%. The patient was 44 years old G4P4 (four vaginal deliveries) and had history of vaginal bleeding, seven weeks of amenorrhea and initial ultrasound findings of tubal ectopic pregnancy. She had laparoscopic partial salpingectomy for possible early tubal ectopic pregnancy by another surgical team one week prior. Interventions With the negative histology of tube, the findings of right interstitial ectopic pregnancy on repeat pelvic ultrasound and an elevated human chorionic gonadotropin (HCG) of 20,520, laparoscopic intact enucleation (similar to myomectomy) of ectopic pregnancy was performed. Techniques used include the intramyometrial injection of diluted vasopressin and unilateral ligation of ascending branches of uterine artery and veins by surgical clips. The operation time was 65 minutes. The estimated blood loss was 30 mL. There was no intra or post-operative complication. Conclusion Laparoscopic intact enucleation of interstitial ectopic pregnancy is possible. It can be done by only using three 5 mm trocars and intact enucleation may reduce the incidence of persistent ectopic pregnancy.