Ovarian Ectopic Pregnancy: Laparoscopic Excision and Ovarian Conservation

Abstract

Video Objective Demonstrate technique of laparoscopic excision of ovarian ectopic pregnancy with ovarian conservation. Setting Tertiary Referral Centre and University Teaching Hospital. Interventions A 23-year-old primigravida presentation at 6 weeks of gestation with a 7-day history of light bleeding and intermittent abdominal pain. Examination findings were unremarkable and the serum human chorionic gonadotropin level was 7157 IU/L. An ultrasound scan showed an ectopic pregnancy in the right adnexa, and primary surgical management was recommended. At laparoscopy, both fallopian tubes were noted to be normal with an ectopic pregnancy within the right ovary. 20 IU argipressin diluted in 80 mL 0.9% sodium hypochlorite was injected between the normal ovarian tissue and the ectopic pregnancy to assist hemostasis and hydro dissection. An ultrasonic device was used to incise the ovarian cortex to identify a plane of dissection between the ectopic pregnancy and the normal ovarian tissue. The ectopic pregnancy was excised with conservation of the ovary. The ovary was subsequently closed with absorbable sutures to ensure hemostasis. The ectopic pregnancy was removed in a bag through a 10-mm incision. The patient made an uneventful recovery. The serum human chorionic gonadotropin level in 7 days was <5IU/L and no further medical management was indicated. Histology confirmed a primary ovarian ectopic pregnancy. Ovarian function was not assessed postoperatively; however, she conceived 6 weeks later with an intrauterine pregnancy. Conclusion This case highlights the importance of considering non-tubal ectopic pregnancies when making a diagnosis based on an ultrasound scan. Ovarian preservation with excision of ectopic pregnancy can be achieved using techniques commonly used for ovarian cystectomy. Recourse to oophorectomy should only be considered in the event of acute hemorrhage. Demonstrate technique of laparoscopic excision of ovarian ectopic pregnancy with ovarian conservation. Tertiary Referral Centre and University Teaching Hospital. A 23-year-old primigravida presentation at 6 weeks of gestation with a 7-day history of light bleeding and intermittent abdominal pain. Examination findings were unremarkable and the serum human chorionic gonadotropin level was 7157 IU/L. An ultrasound scan showed an ectopic pregnancy in the right adnexa, and primary surgical management was recommended. At laparoscopy, both fallopian tubes were noted to be normal with an ectopic pregnancy within the right ovary. 20 IU argipressin diluted in 80 mL 0.9% sodium hypochlorite was injected between the normal ovarian tissue and the ectopic pregnancy to assist hemostasis and hydro dissection. An ultrasonic device was used to incise the ovarian cortex to identify a plane of dissection between the ectopic pregnancy and the normal ovarian tissue. The ectopic pregnancy was excised with conservation of the ovary. The ovary was subsequently closed with absorbable sutures to ensure hemostasis. The ectopic pregnancy was removed in a bag through a 10-mm incision. The patient made an uneventful recovery. The serum human chorionic gonadotropin level in 7 days was <5IU/L and no further medical management was indicated. Histology confirmed a primary ovarian ectopic pregnancy. Ovarian function was not assessed postoperatively; however, she conceived 6 weeks later with an intrauterine pregnancy. This case highlights the importance of considering non-tubal ectopic pregnancies when making a diagnosis based on an ultrasound scan. Ovarian preservation with excision of ectopic pregnancy can be achieved using techniques commonly used for ovarian cystectomy. Recourse to oophorectomy should only be considered in the event of acute hemorrhage.