Robotic-Assisted Laparoscopic Resection of a Cornual Ectopic Pregnancy: Video Presentation

Abstract

Study Objective A cornual ectopic pregnancy is a pregnancy that implants in the cornua, the most proximal portion of the fallopian tube lying within the myometrium. Cornual ectopics comprise only 2-3% of cases of ectopic pregnancy, however, they have a significantly higher risk of maternal death, at 2-2.5%. This is due to the abundant blood supply to the cornua from both uterine and ovarian vessels leading to greater risk of hemorrhage and hypovolemic shock. This video demonstrates how a cornual ectopic pregnancy can be treated using minimally invasive technique with minimal blood loss. We also explore the use of vasopressin as an adjunct in surgery to minimize blood loss. Design Case Report. Setting Tertiary care center outside of a major city in the United States. Patients or Participants We present a case of a 24-year-old G3P1011 at 7 weeks gestation by last menstrual period who presented to the Emergency Department with severe left lower quadrant pain for 1 day. She was found to have a cornual ectopic pregnancy. Interventions The cornual ectopic was treated by robotic-assisted laparoscopy. Her treatment was further enhanced by the use of dilute vasopression injected into the cervix and the cornua. The ectopic was dissected using monopolar scissors and removed from the uterus intact. The defect in the uterus was closed with a barbed suture. Measurements and Main Results The entire procedure took 50 minutes with an estimated blood loss of less than 10cc. Postoperative course was uncomplicated with a negative bhCG at follow-up on postoperative day 27. Conclusion Robotic-assisted laparoscopy is a safe and effective approach for resection of cornual ectopic pregnancies. Vasopressin can be used as an adjunct to minimize blood loss. Future research should continue to explore minimally invasive techniques for cornual ectopic resection, focusing on the use of adjunct procedures and medications to reduce surgical time and minimize blood loss. A cornual ectopic pregnancy is a pregnancy that implants in the cornua, the most proximal portion of the fallopian tube lying within the myometrium. Cornual ectopics comprise only 2-3% of cases of ectopic pregnancy, however, they have a significantly higher risk of maternal death, at 2-2.5%. This is due to the abundant blood supply to the cornua from both uterine and ovarian vessels leading to greater risk of hemorrhage and hypovolemic shock. This video demonstrates how a cornual ectopic pregnancy can be treated using minimally invasive technique with minimal blood loss. We also explore the use of vasopressin as an adjunct in surgery to minimize blood loss. Case Report. Tertiary care center outside of a major city in the United States. We present a case of a 24-year-old G3P1011 at 7 weeks gestation by last menstrual period who presented to the Emergency Department with severe left lower quadrant pain for 1 day. She was found to have a cornual ectopic pregnancy. The cornual ectopic was treated by robotic-assisted laparoscopy. Her treatment was further enhanced by the use of dilute vasopression injected into the cervix and the cornua. The ectopic was dissected using monopolar scissors and removed from the uterus intact. The defect in the uterus was closed with a barbed suture. The entire procedure took 50 minutes with an estimated blood loss of less than 10cc. Postoperative course was uncomplicated with a negative bhCG at follow-up on postoperative day 27. Robotic-assisted laparoscopy is a safe and effective approach for resection of cornual ectopic pregnancies. Vasopressin can be used as an adjunct to minimize blood loss. Future research should continue to explore minimally invasive techniques for cornual ectopic resection, focusing on the use of adjunct procedures and medications to reduce surgical time and minimize blood loss.