Surgical Technique for Removal of an Ovarian Ectopic Pregnancy: Minimizing Disruption of the Ovarian Stroma

Abstract

Study Objective To successfully complete laparoscopic removal of an ovarian ectopic pregnancy without the use of electrosurgery and with minimization of damage to the ovarian stroma. Design N/A Setting The patient was placed in dorsal lithotomy position in steep Trendelenburg to aid in performance of pelvic laparoscopy. Insufflation was carried out to 15mmHg. A primary 10mm umbilical trocar was used for the camera and three additional 5mm assist ports were placed. Patients or Participants The patient is a 34-year-old G4P1021 who was diagnosed with presumed left adnexal ectopic pregnancy at 6 weeks gestation following ovulation induction with intrauterine insemination. The patient required three doses of methotrexate in order to experience a decrease in HCG level. The patient then presented with worsening pelvic pain, and repeat transvaginal ultrasound showed presumed left ovarian ectopic pregnancy without evidence of rupture. After options counseling, she opted to proceed with laparoscopic removal of the ectopic pregnancy. Interventions Diagnostic laparoscopy, removal of left ovarian ectopic pregnancy using an Endoloop device Measurements and Main Results Final pathology confirmed ovarian ectopic pregnancy. HCG levels declined to Conclusion Ovarian ectopic pregnancies can be safely and effectively removed using this simple technique while minimizing the risk of damage to ovarian stroma that may occur when performing electrosurgery or a wedge resection.