Laparoscopic Hysterectomy for Failed Labor Induction Abortion Is Neither Frugal nor Innovative.

Abstract

The case report of Baekelandt and Bosteels [ 1 Baekelandt J. Bosteels J. Laparoscopic hysterotomy for a failed termination of pregnancy: a first case report with demonstration of a new surgical technique. J Minim Invasive Gynecol. 2015; 22: 544 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar ] describes “a new technique of hysterotomy via laparoscopy for a failed termination of pregnancy, as an alternative for a hysterotomy via laparotomy.” This unfortunate patient was receiving care at an institution that attempted for 7 days to induce labor for trisomy 21 at 18 weeks' gestation. Based on Belgian law, she also likely had to endure a compulsory 6-day waiting period. The authors performed a procedure they claim is “frugally innovative” and could be performed in “low resource settings.” The irony in this statement is remarkable. Have these physicians ever heard of a dilation and evacuation procedure, which is the preferred method of terminating pregnancies in the second trimester? Their novel technique is neither frugal nor innovative. The physicians who cared for this patient put her through a long induction only to be followed by invasive surgery that resulted in retained placental tissue for which she had another procedure (hysteroscopy). The safety of dilation and evacuation over hysterotomy was established decades ago, and performing the procedure laparoscopically will not change such conclusions [ 2 Grimes D.A. Schulz K.F. Morbidity and mortality from second-trimester abortion. J Reprod Med. 1985; 30: 505-514 PubMed Google Scholar ]. Dilation and evacuation results in fewer complications than all methods of labor induction abortion that do not involve mifepristone [ 3 Whitley K.A. Trinchere K. Prutsman W. Quiñones J.N. Rochon M.L. Midtrimester dilation and evacuation versus prostaglandin induction: a comparison of composite outcomes. Am J Obstet Gynecol. 2011; 205: 386 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar , 4 Autry A.M. Hayes E.C. Jacobson G.F. Kirby R.S. A comparison of medical induction and dilation and evacuation for second-trimester abortion. Am J Obstet Gynecol. 2002; 187: 393-397 Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar , 5 Bryant A.G. Grimes D.A. Garrett J.M. Stuart G.S. Second-trimester abortion for fetal anomalies or fetal death: labor induction compared with dilation and evacuation. Obstet Gynecol. 2011; 117: 788-792 Crossref PubMed Scopus (57) Google Scholar , 6 Grossman D. Constant D. Lince N. Alblas M. Blanchard K. Harries J. Surgical and medical second trimester abortion in South Africa: a cross-sectional study. BMC Health Serv Res. 2011; 11: 224 Crossref PubMed Scopus (29) Google Scholar ], including in low-resource settings [ 6 Grossman D. Constant D. Lince N. Alblas M. Blanchard K. Harries J. Surgical and medical second trimester abortion in South Africa: a cross-sectional study. BMC Health Serv Res. 2011; 11: 224 Crossref PubMed Scopus (29) Google Scholar ]. The appropriate message of this case report should not be that the described technique can be used as a means to avoid hysterotomy via laparotomy. Rather, the authors would have served the medical community better by pointing out that they had to resort to such a procedure because a trained surgeon was not available to perform a dilation and evacuation procedure, a much less invasive and safer second-trimester uterine evacuation techniques. This patient had a hysterotomy with retained placental tissue because the standard of medical care was not as high as it should have been for someone needing a second-trimester abortion at the authors' institution. Laparoscopic Hysterotomy for a Failed Termination of Pregnancy: A First Case Report With Demonstration of a New Surgical TechniqueJournal of Minimally Invasive GynecologyVol. 22Issue 4PreviewTo show a new technique of hysterotomy via laparoscopy for a failed termination of pregnancy as an alternative for a hysterotomy via laparotomy. Full-Text PDF Response to Letter to the Editor Regarding “Laparoscopic Hysterotomy for a Failed Termination of Pregnancy: A First Case Report With Demonstration of a New Surgical Technique”Journal of Minimally Invasive GynecologyVol. 22Issue 5PreviewThe video article by Baekelandt and Bosteels [1] presents the first case of a hysterotomy by laparoscopy as a less-invasive alternative to laparotomy. It is definitely not intended to be an alternative for a safe dilation and evacuation (D&E), which is obviously even less invasive. If our article left any room for misinterpretation about that, we want to thank the writers of the letter to the editor for stressing this important fact and for basing their arguments on good scientific evidence. Full-Text PDF