A Purse-String Approach to Laparoscopic Cornuostomy for Interstitial Ectopic Pregnancy

Abstract

Study Objective To review surgical techniques for tissue dissection in interstitial ectopic pregnancies, and demonstrate a novel approach to resection using a purse-string suture for improved hemostasis and minimized surgical morbidity. Design Brief literature review, clinical history, and video documentation. Setting The patients were both placed in a dorsal lithotomy position for laparoscopy in a tertiary care centre. Patients or Participants The two patients selected for inclusion in the video were chosen based upon confirmation of diagnosis of interstitial ectopic pregnancy, and primary surgeon at time of OR for operative consistency. Patient 1 was a 36-year old G5P1 woman who presented with bleeding at 8 weeks 5 days gestational age. Patient 2 was a 35 year-old G2P1 woman who presented with abdominal pain at 11 weeks gestational age, with additional risk factors for surgical complications. Interventions Laparoscopic cornuostomy for interstitial ectopic pregnancy Measurements and Main Results Pre-operatively, both diagnoses were confirmed with serial ultrasound. Findings at time of laparoscopy supported the above, with clear distension at the uterine cornea without normal endometrial implantation Our video demonstrates a four-step approach to resection of such pregnancies through laparoscopic cornuostomy. This includes isolating the pregnancy by salpingectomy and ligation of the utero-ovarian ligament, ensuring hemostasis with a novel purse string suture around the pregnancy at its equatorial line and injection of vasopressin, resection using a linear incision, and a layered repair of the uterine defect. Conclusion Although rare, interstitial ectopic pregnancies present a distinct surgical challenge, as they often present with rupture and carry a significant risk of hemorrhage at time of resection. The purse string suture is a useful tool in minimizing bleeding, and allows for interstitial ectopic pregnancies to be excised with a minimally invasive cornuostomy, even in cases of significant anatomical distortion.