Expanding Horizons: Laparoscopic Management of Unruptured Cornual Heterotopic Pregnancy Safeguarding Intrauterine Pregnancy

Abstract

<h3>Study Objective</h3> Feasibility of Minimally invasive surgery to handle extremely rare conditions of heterotopic cornual ectopic pregnancy. <h3>Design</h3> Compilation of videos consisting of four surgical procedures over six years performed on a patient with specific focus on heterotopic cornual ectopic pregnancy managed laparoscopically. <h3>Setting</h3> Operative laparoscopy for cornual ectopic pregnancy was performed under general anaesthesia in semi lithotomy position. Optical 11 mm trocar was introduced from umbilicus and other three ancillary 6 mm ports were used. C section of same patient at full term was carried out under regional anaesthesia with Pfannenstiel incision. <h3>Patients or Participants</h3> The patient had undergone laparoscopic bilateral neosalpingostomy as a part of fertility restoration surgery which was followed by bilateral salpingectomy for recurrent hydrosalpinx and tubal ectopic pregnancy. Following which patient underwent Assisted reproductive technique but unfortunately developed rare form of multiple gestation (heterotopic pregnancy with one left cornual ectopic component and second healthy intrauterine pregnancy). It was diagnosed in time and treated with operative laparoscopy. The intrauterine pregnancy continued till term and a healthy singleton child was delivered by C section at 37th week. <h3>Interventions</h3> I was prudent to avoid prolonged use of general anaesthesia and to reduce use of electrocautery on gravid uterus. For achieving effective hemostasis four stay sutures with delayed absorbable suture material was taken on both sides and base of ectopic gestation which was very vascular lesion due to gravid uterus. <h3>Measurements and Main Results</h3> With minimal use of electrocautery and without using vasoconstrictors or uterine artery ligation, extremely vascular cornual ectopic pregnancy was safely removed by operative laparoscopy. Myometrial defect was properly reconstructed with delayed absorbable sutures, without causing any short term or long-term harm to ongoing precious intrauterine pregnancy. <h3>Conclusion</h3> Extremely rare and complex situation of heterotopic cornual ectopic pregnancy can be very safely managed with proper application of principles of minimal invasive surgery safeguarding the intrauterine pregnancy.