Laparoscopic Excision of an Ectopic Pregnancy in a Non-Communicating Uterine Horn

Abstract

Study Objective Describe an approach to a laparoscopic excision of a uterine horn ectopic pregnancy. Design N/A. Setting The patient was positioned in dorsal lithotomy in stirrups. Four ports were placed including an infra-umbilical port, a supra-pubic port, and two right or left lower quadrant ports 10mm from the midline above the level of the anterior superior iliac spine. Patients or Participants N/A. Interventions The right round ligament was coagulated and cut. The vesicouterine peritoneum was incised and the perivesical space was opened. The right fallopian tube was coagulated along the mesosalpinx. The right uterine artery and vein were isolated laterally and traced to the right horn pregnancy as well as to the left unicornuate uterus. A purse-string suture was performed using a running unidirectional barbed suture to isolate the vasculature pedicle feeding the horn pregnancy. The horn was separated from the uterus using the Harmonic Ace. The resulting pedicle was oversewed with barbed suture. Measurements and Main Results N/A. Conclusion Use of a purse string suture can be considered to minimize blood loss and spare the uterine vasculature at the time of uterine horn ectopic excision. Describe an approach to a laparoscopic excision of a uterine horn ectopic pregnancy. N/A. The patient was positioned in dorsal lithotomy in stirrups. Four ports were placed including an infra-umbilical port, a supra-pubic port, and two right or left lower quadrant ports 10mm from the midline above the level of the anterior superior iliac spine. N/A. The right round ligament was coagulated and cut. The vesicouterine peritoneum was incised and the perivesical space was opened. The right fallopian tube was coagulated along the mesosalpinx. The right uterine artery and vein were isolated laterally and traced to the right horn pregnancy as well as to the left unicornuate uterus. A purse-string suture was performed using a running unidirectional barbed suture to isolate the vasculature pedicle feeding the horn pregnancy. The horn was separated from the uterus using the Harmonic Ace. The resulting pedicle was oversewed with barbed suture. N/A. Use of a purse string suture can be considered to minimize blood loss and spare the uterine vasculature at the time of uterine horn ectopic excision.