Laparoscopic Management of an Interstitial Ectopic Pregnancy

Abstract

Study Objective An ectopic pregnancy, also known as a cornual ectopic pregnancy, is rare form of tubal ectopic pregnancy and is associated with high maternal mortality (2-2.5%). The objective of this film is to review the epidemiology, presentation, diagnosis and management of an ectopic pregnancy. Design This is a case report of a patient who presented with an ectopic pregnancy. Setting The preoperative, intraoperative and postoperative course took place at a center for minimally invasive gynecologic surgery. The surgery was performed with the patient in dorsal lithotomy position. Patients or Participants N/A Interventions In this film, we review the specific technique for performing a laparoscopic cornual wedge resection with a laparoscopic ultrasonic dissector and removal of the specimen through a laparoscopic specimen retrieval bag. We also identify surgical principles for reducing intraoperative blood loss and improving patient outcomes. Lastly, we review postoperative and fertility outcomes and expectations. Measurements and Main Results Key strategies were employed to minimize intraoperative blood loss including administration of tranexamic acid at the start of the procedure, myometrial infiltration with dilute vasopressin and maintaining view of anatomic landmarks to avoid encountering the utero-ovarian vasculature. The ectopic pregnancy was successfully resected, and the patient's fertility was preserved. Conclusion After watching the film, the viewer should be able to diagnose an ectopic pregnancy on transvaginal pelvic ultrasound by identifying the interstitial line sign and be able to reasonably differentiate it from other forms of ectopic pregnancy. The viewer will understand the management options including both local and systemic methotrexate, as well as surgical options, including laparoscopic cornual wedge resection. The viewer will have a grasp of the surgical principles employed to reduce intraoperative blood loss and the evidence for counseling patients regarding future fertility.