Interstitial Pregnancy: Surgical Management by Laparoscopic Cornuostomy

Abstract

<h3>Study Objective</h3> Our objective is to add to current literature support for laparoscopic cornuostomy as a safe and effective minimally invasive surgical management for interstitial (cornual) ectopic pregnancy. <h3>Design</h3> Surgical video. <h3>Setting</h3> Highland Hospital, Alameda Health System (safety-net county hospital). Patient was positioned in dorsal lithotomy with both arms tucked at the side. Standard laparoscopic and hysteroscopic equipment was used including four 5mm laparoscopic ports. <h3>Patients or Participants</h3> A single patient was involved in this surgical video. <h3>Interventions</h3> Same-day laparoscopic cornuostomy and diagnostic hysteroscopy with attempted tubal cannulation. <h3>Measurements and Main Results</h3> Multiple telephone visits with the patient to monitor clinical symptoms and post-op recovery, including Beta hCG measurements until Beta hCG level was undetectable. Beta hCG levels: 11, 783 (pre-op) -> 47 (15 days post-op) -> 7 (34 days post-op) -> undetectable (44 days post-op). <h3>Conclusion</h3> Laparoscopic cornuostomy for the surgical management of interstitial pregnancy, as opposed to cornual wedge resection, should be considered, particularly in stable patients with intact ectopic pregnancy. The minimally invasive techniques we demonstrate in this video are reproducible, effective, and efficient. Additional study is required to understand how this surgical approach could impact ipsilateral tubal patency and pregnancy outcomes such as uterine rupture.