Laparoscopic cornuostomy for interstitial ectopic pregnancy: a case series and step-by-step demonstration

Abstract

Presenting a case series of IEP managed surgically through laparoscopic cornuostomy, illustration of the technique modification with successful treatment at various gestational age, reviewing the outcomes and the advantages of this surgical technique for IEP. After appropriate diagnosis using diagnostic ultrasound criteria for interstital ectopic pregnancy, Laparoscopy was performed confirming the diagnosis of IEP lateral to the insertion of the round ligament. Two stay sutures were placed under the ectopic in the first case due to the high risk of hemorrhage. In the following three cases, diluted vasopressin (20 IU diluted in 100 ml of normal saline) was injected circumferentially at the uterotubal junction with no stay sutures required. A linear incision was performed over the most prominent area of the IEP. Hydro-dissection was utilized followed by using a laparoscopic grasper to remove the products of conception. Argon beam coagulation was used to secure hemostasis in the myometrial bed. The Cornuostomy was closed using horizontal mattress sutures followed by continuous running sutures. The post-operative course was uncomplicated. All patients were discharged on the following day of surgery. The B-hcg levels were followed to non-pregnant levels in all cases. There were no cases of persistent interstitial ectopic pregnancy requiring additional medical methotrexate. Three patients (number 1, 2, 4) had successful subsequent pregnancies and deliveries without any complication. Patient number 3 was lost for follow up. In the presence of an experienced laparoscopic surgeon, laparoscopic cornuostomy is safe and effective in treating IEP even in cases with advanced gestational age.