1409 Laparoscopic Approach to Cornual Ectopic Pregnancy

Abstract

Video Objective Cornual ectopic pregnancies are a rare variant of ectopic pregnancies which are difficult to diagnose and can cause significant intraperitoneal bleeding. There are no current guidelines to decipher between medical or surgical management, even amongst surgical approaches there is debate over minimally invasive versus traditional laparotomies. This video demonstrates a successful laparoscopic approach to the management of a cornual ectopic pregnancy. Setting The patient is a 44 year old female with plateauing serum beta hcg levels who was diagnosed with a right cornual ectopic pregnancy by transvaginal ultrasound. She was admitted and treated at a tertiary care center in Brooklyn, New York. Interventions The risks, benefits and alternatives of a laparoscopic resection of the cornual ectopic pregnancy was discussed with the patient, who elected to proceed with the surgery. The right cornual ectopic was identified intraoperatively by transvaginal ultrasound. Vasopressin was then injected into the right cornua to decrease blood loss. Endoshear scissors were then used to gently dissect the right coruna, and the gestational sac was removed intact. A barbed suture was then used to repair the hysterotomy which was hemostatic. Anti-adhesion barrier was then placed over the right cornua at the end of the procedure. The patient tolerated the procedure well and was discharged home on the same day of the procedure with an uneventful postoperative course. Conclusion Cornual ectopic pregnancies are a significant cause of morbidity and mortality and remain difficult to diagnose and treat. Laparoscopic treatment of cornual ectopic pregnancies lead to improved patient outcomes with faster recovery times, and decreased length of hospitalization compared with laparotomies. Thus, when possible, laparoscopic management of cornual ectopic pregnancies should be attempted and can increase patient satisfaction.