Cornual Wedge Resection Research Articles

Vasopressin Injection Purse-String Ectopic Resection technique for laparoscopic management of cornual ectopic pregnancy

Although cornual pregnancy is a rare form of ectopic pregnancy, the associated mortality rate is considerably higher than that of ectopic pregnancy overall. Historically, cornual ectopic pregnancy has been treated via laparotomy. With advancements in technology, equipment, and technique, laparoscopy offers a safer approach for the management of cornual pregnancy. However, laparoscopy of this nature requires excellent technique. The Vasopressin Injection Purse-String Ectopic Resection technique serves as an effective strategy for the laparoscopic management of cornual ectopic pregnancy. First, dilute vasopressin is administered into the myometrium surrounding the pregnancy. Next, a purse-string stitch is placed in the myometrium circumferential to the pregnancy. Finally, the pregnancy is excised by cornual wedge resection, and the defect is repaired using the attached remaining suture from the purse-string stitch. The Figureshows the graphical depiction of the Vasopressin Injection Purse-String Ectopic Resection technique, and the Video shows a laparoscopic recording of the Vasopressin Injection Purse-String Ectopic Resection technique. Between 2012 and 2022, 17 patients underwent a laparoscopic cornual ectopic pregnancy resection at a high-volume academic hospital and its affiliated community hospital. This case series revealed a mean operative time of 107 minutes, with a mean estimated blood loss of 41 mL for nonruptured ectopic pregnancies and 412 mL for ruptured ectopic pregnancies. No case was converted to laparotomy. Our findings suggest that the integration of the vasopressin administration and the pursue-string stitch placement minimizes blood loss and mitigates the risk of conversion to laparotomy for both nonruptured and ruptured cornual ectopic pregnancies.

Cornual Pregnancy.

Cornual pregnancy (CP) is a subtype of ectopic pregnancy that is implanted in the interstitial segment of the fallopian tube which is defined as the tubal section crossing uterine muscular tissue. Widely recognized risk factors for CP are endometriosis, uterine leiomyomata, or pelvic inflammatory disease; all these diseases can cause tubal anatomic changes and consequently alter embryo physiological implant process. Many treatment options are available for this condition each one must be tailored according to patient and operating scenario. The incidence of uterine ruptures in the scarred uterus appears to be low, but the fear of it remains and therefore medical treatment might be favored over cornual wedge resection. The actual risk of uterine rupture after medical treatment is unknown. Multiple testing strategies exist to diagnose CP, but caution needs to be used to avoid a false diagnosis.

Fertility-Sparing Cornual Wedge Resection for Management of GTN

<h3>Study Objective</h3> To describe the case of a 30-year-old female with cornual ectopic pregnancy treated with methotrexate with normalization of beta-hCG who subsequently developed GTN at the prior ectopic site. The patient desired future fertility and was treated with actinomycin-D with optimal response and negative beta-hCG for four months, yet the mass was persistent. The patient desired future fertility, and with guidance from gynecologic oncology and reproductive endocrinology, decision was made to proceed with a conservative operation. We demonstrate the technique of cornual wedge resection for treatment of GTN. <h3>Design</h3> Case-report <h3>Setting</h3> The patient was placed in dorsal lithotomy position with lower extremities in Allen-type stirrups and was placed in steep Trendelenburg position. <h3>Patients or Participants</h3> N/A - single patient, case report <h3>Interventions</h3> Actinomycin-D administered until beta-hCG negative for 4 months, mass noted to be persistent at uterine cornu, laparoscopic cornual wedge resection for removal of GTN given patient's desire to maintain future fertility <h3>Measurements and Main Results</h3> Pathology of the mass demonstrated necrotic chorionic villi and placental remnants, negative for malignancy. Follow up transvaginal ultrasound 3 months postoperatively demonstrated no residual mass and no uterine defect. Checking beta-hCG monthly until 12 months with negative tests, then will attempt to conceive with support from reproductive endocrinology and planned cesarean delivery similar to the management of patient's post-myomectomy. <h3>Conclusion</h3> With subspecialty support from gynecologic oncology and reproductive endocrinology, cornual wedge resection should be considered a viable option for treatment of GTN in patients who desire future fertility.

8974 Laparoscopic Loop and Stitch Technique in Tubal Stump Ectopic Pregnancy

<h3>Study Objective</h3> To describe a new technique of loop and stitch technique in tubal stump ectopic pregnancy <h3>Design</h3> Description of technique with narrated video clip <h3>Setting</h3> Academic tertiary hospital <h3>Patients or Participants</h3> 33-year-old female with tubal factor infertility was diagnosed with tubal stump ectopic pregnancy at 5+3 weeks period of gestation. She had history of right tubal ectopic conceived through IVF in the past. Serum beta HCG showed an inadequate rise of 21%. Diagnosis was facilitated by 2D and 4D ultrasound findings. <h3>Interventions</h3> Laparoscopy confirmed our diagnosis of ectopic in right tubal stump. Diluted Vasopressin was injected at the base of stump. Circumferential stitches were taken all around the base of the stump using barbed vicryl suture. Ectopic mass was completely removed with the tubal remnant using harmonic scalpel. Serosal breach was repaired with same suture. Contralateral salpingectomy was also done. <h3>Measurements and Main Results</h3> Laparoscopic loop and stitch technique is minimally invasive thus avoiding cornual wedge resection and blood loss. Uterine myometrium was saved from damage thus preventing future major obstetric catastrophe like uterine rupture and morbidly adherent placenta. <h3>Conclusion</h3> Diagnosis of stump ectopic requires high degree of suspicion with history, examination and ultrasound findings. This new minimally invasive technique of loop and stitch which when offered timely enhances women's future fertility and reproductive outcomes.

Interstitial Pregnancy: Surgical Management by Laparoscopic Cornuostomy

<h3>Study Objective</h3> Our objective is to add to current literature support for laparoscopic cornuostomy as a safe and effective minimally invasive surgical management for interstitial (cornual) ectopic pregnancy. <h3>Design</h3> Surgical video. <h3>Setting</h3> Highland Hospital, Alameda Health System (safety-net county hospital). Patient was positioned in dorsal lithotomy with both arms tucked at the side. Standard laparoscopic and hysteroscopic equipment was used including four 5mm laparoscopic ports. <h3>Patients or Participants</h3> A single patient was involved in this surgical video. <h3>Interventions</h3> Same-day laparoscopic cornuostomy and diagnostic hysteroscopy with attempted tubal cannulation. <h3>Measurements and Main Results</h3> Multiple telephone visits with the patient to monitor clinical symptoms and post-op recovery, including Beta hCG measurements until Beta hCG level was undetectable. Beta hCG levels: 11, 783 (pre-op) -> 47 (15 days post-op) -> 7 (34 days post-op) -> undetectable (44 days post-op). <h3>Conclusion</h3> Laparoscopic cornuostomy for the surgical management of interstitial pregnancy, as opposed to cornual wedge resection, should be considered, particularly in stable patients with intact ectopic pregnancy. The minimally invasive techniques we demonstrate in this video are reproducible, effective, and efficient. Additional study is required to understand how this surgical approach could impact ipsilateral tubal patency and pregnancy outcomes such as uterine rupture.

Decidualized Juvenile Cystic Adenomyoma Mimicking a Cornual Heterotopic Pregnancy

<h3>Study Objective</h3> To describe a rare case of a juvenile cystic adenomyoma presenting as a heterotopic pregnancy. <h3>Design</h3> Case report. <h3>Setting</h3> Private teaching hospital. <h3>Patients or Participants</h3> A 26-yo G3P1 at 7wga presented to the emergency department with complaint of vaginal spotting and mild cramping. Ultrasound identified a heterotopic pregnancy. An intrauterine pregnancy was noted with a 1.9cm gestational sac, a 1.1cm CRL, and FHR 161bpm. A second gestational sac was noted in the posterior left uterus measuring 1.58cm with CRL 0.94cm and <5mm of myometrium surrounding the sac. No cardiac activity detected. <h3>Interventions</h3> The patient was counseled regarding options for management including abortive vs non-abortive, medical vs surgical. She ultimately decided to undergo surgical treatment with preservation of the intrauterine pregnancy. Intraoperative laparoscopic ultrasound was performed with similar findings. Robotic assisted cornual wedge resection and removal of the ectopic mass was performed with preservation of the ipsilateral fallopian tube and intrauterine pregnancy. <h3>Measurements and Main Results</h3> Final pathology failed to demonstrate any fetal tissue, but rather demonstrated cystic adenomyoma. <h3>Conclusion</h3> Juvenile cystic adenomyosis (JCA) is a rare form of focal adenomyosis which is usually located near the uterine insertion of the round ligament, contains a cystic inner area >1cm and is encountered before the age of 30 years. Some authors report JCA to be an accessory cavitated uterine mass (ACUM) anomaly developing because of gubernaculum dysfunction. The only difference between the two conditions is the presence of a denser area of adenomyosis surrounding the cystic area lined with endometrium in JCA. This case demonstrates decidual changes observed in ectopic endometrial tissue within an area may be misdiagnosed as a focus of ectopic pregnancy. In non-emergency situations, waiting for the decidualization effect of ectopic endometrium to subside can help in the definitive diagnosis of such cases.

3D Ultrasound Preoperative Planning for a Laparoscopic Cornual Wedge Resection

Study Objective The objective of this study was to investigate the role of three-dimensional (3D) ultrasound in preoperative diagnosis and planning for a laparoscopic cornual wedge resection for an interstitial ectopic pregnancy. Design Video case report. Setting Operating room, patient positioned in dorsal lithotomy with Allen stirrups. The case was completed laparoscopically after direct entry in the left upper quadrant, due to the presence of umbilical mesh. Patients or Participants One patient who presented with an interstitial ectopic pregnancy. Interventions 3D ultrasound and a laparoscopic cornual wedge resection. Measurements and Main Results 3D ultrasound was able to quickly diagnose an interstitial ectopic pregnancy. 3D ultrasound was also useful in preoperative planning for a laparoscopic cornual wedge resection. Conclusion Interstitial ectopic pregnancies are difficult to diagnose, frequently requiring MRI for preoperative planning. 3D ultrasound is a promising modality for expedited and accurate diagnosis of interstitial ectopic pregnancies, especially when urgent surgery is indicated. We present a case of an interstitial ectopic pregnancy diagnosed with 3D ultrasound, that was ultimately successfully treated with a laparoscopic cornual wedge resection without complication. The objective of this study was to investigate the role of three-dimensional (3D) ultrasound in preoperative diagnosis and planning for a laparoscopic cornual wedge resection for an interstitial ectopic pregnancy. Video case report. Operating room, patient positioned in dorsal lithotomy with Allen stirrups. The case was completed laparoscopically after direct entry in the left upper quadrant, due to the presence of umbilical mesh. One patient who presented with an interstitial ectopic pregnancy. 3D ultrasound and a laparoscopic cornual wedge resection. 3D ultrasound was able to quickly diagnose an interstitial ectopic pregnancy. 3D ultrasound was also useful in preoperative planning for a laparoscopic cornual wedge resection. Interstitial ectopic pregnancies are difficult to diagnose, frequently requiring MRI for preoperative planning. 3D ultrasound is a promising modality for expedited and accurate diagnosis of interstitial ectopic pregnancies, especially when urgent surgery is indicated. We present a case of an interstitial ectopic pregnancy diagnosed with 3D ultrasound, that was ultimately successfully treated with a laparoscopic cornual wedge resection without complication.

Robotic Assisted Laparoscopic Wedge Resection of a Large Cornual Ectopic Pregnancy

<h3>Study Objective</h3> To demonstrate the steps of a wedge resection of a large cornual ectopic pregnancy using a robotic assisted approach. <h3>Design</h3> A guided explanation of the surgery using video. <h3>Setting</h3> The surgery was completed at a university hospital using the Da Vinci Xi Robot. <h3>Patients or Participants</h3> A 38-yo G7P1051 with a history of chronic hypertension who was incidentally found to have a cornual ectopic pregnancy measuring 11 weeks 4 days on her initial prenatal ultrasound. <h3>Interventions</h3> Robotic Assisted Laparoscopic Cornual Wedge Resection. <h3>Measurements and Main Results</h3> On initial prenatal ultrasound, the patient was found to have a cornual ectopic pregnancy on the right. Crown rump length measured 47mm corresponding with a gestational age of 11 weeks and 4 days. She was asymptomatic. She presented immediately to the hospital and underwent an urgent robotic assisted laparoscopic cornual wedge resection that evening. Estimated blood loss was 100cc. She did well postoperatively and went home the same day. <h3>Conclusion</h3> We present a case of a robot assisted wedge resection of a large cornual ectopic pregnancy as an alternative to straight stick laparoscopy or laparotomy. Although robotic assisted cases are known to have longer operating times, as with myomectomy, a robot approach can potentially help to decrease blood loss when managing large cornual ectopic pregnancies.

Minimally invasive surgical management of a cornual ectopic pregnancy, with and without a concurrent intrauterine pregnancy

To describe techniques for resection of a cornual heterotopic pregnancy. This video demonstrates a surgical technique for excision of a cornual heterotopic pregnancy with narrative video footage using two case examples. The incidence of cornual heterotopic pregnancy is unknown; however, the incidence of heterotopic pregnancy itself has increased through the use of assisted reproductive technologies and the majority of cornual heterotopic pregnancies occur after assisted reproductive technologies use. These cases have been treated traditionally using exploratory laparotomy and cornual wedge resection with good outcomes. With advancements in minimally-invasive surgical techniques, laparoscopic resection of cornual heterotopic pregnancies has been demonstrated to be safe and feasible. A patient with an 8-week cornual heterotopic pregnancy and a patient with a 10-week cornual ectopic pregnancy. Laparoscopic resection of the cornual ectopic pregnancy. Feasibility of a "purse-string" technique for the resection of a heterotopic cornual pregnancy. Robotic-assisted laparoscopic resection of a cornual heterotopic pregnancy can be performed with minimal blood loss with the use of the "purse-string" technique in settings where vasopressin cannot be used for hemostasis. This technique includes the use of a 2-0 V-Loc suture in a circumferential fashion around the ectopic pregnancy, which allows for faster suturing and immediate tension at the myometrium. The same suture is then used to close the defect, which allows for a simpler and efficient closure with minimal entry into the myometrium. In this video, we demonstrate the successful resection of cornual heterotopic pregnancy using a "purse-string" surgical technique. This technique allows for minimal blood loss in cases where additional techniques for hemostasis cannot be used, such as injection of vasopressin and uterine artery ligation.

Ultrasonic diagnosis of asymptomatic rupture of uterine in second trimester of pregnancy after laparoscopic surgery for interstitial pregnancy: a case report

BackgroundUterine rupture is a rare, life-threatening event in obstetrics that may be fatal for the mother and fetus. Therefore, obstetricians need to pay attention to and should consider the antenatal diagnosis of uterine rupture in women having its risk factors. Successful conservative management for asymptomatic uterine rupture due to previous laparoscopic surgery for interstitial pregnancy has already been reported but remains understudied.Case presentationA 39-year-old woman was diagnosed asymptomatic uterine rupture at 22 weeks gestation by a routine second-trimester ultrasound scan. She had a history of laparoscopic salpingectomy with cornual wedge resection for interstitial pregnancy 10 months before this pregnancy. Refusing doctor’s twice advice of terminating the pregnancy, the patient insisted carrying on the pregnancy, and followed up by ultrasound and magnetic resonance imaging. Fetal growth was appropriate, fetal movements were good and the patient had no symptoms, without uterine contraction or amniotic fluid loss throughout follow-up period. Caesarean section was carried out at 34 + 1 weeks with a good maternal and neonatal outcome.ConclusionsA previous history of laparoscopic salpingectomy with cornual wedge resection could be a risk factor for uterine rupture in pregnant women. Sonographers should be alert to this potential risk in pregnant women with a history of laparoscopic salpingectomy with cornual wedge resection even in asymptomatic patients.

A case study of ruptured cornual ectopic with successful outcome in subsequent pregnancy

Cornual pregnancy is a fearful condition with dreadful complications. Due to rarity and late presentation, it poses diagnostic and therapeutic challenges. There is no consensus on treatment strategies till date and risk of rupture after repair in subsequent pregnancy always remains a major concern. We hereby discuss a case of 27 year female who presented with ruptured cornual ectopic pregnancy, underwent cornual wedge resection with repair and had subsequent pregnancy with a successful outcome.

Hysteroscopic Resection of an Interstitial Ectopic Pregnancy

Study Objective We demonstrate a novel approach for treatment of an interstitial ectopic pregnancy via hysteroscopic resection under laparoscopic guidance. Design N/A Setting The patient was a 29 year old G2P0010 with an enlarging interstitial pregnancy despite treatment with methotrexate. The surgery was performed in an ambulatory center affiliated with a tertiary teaching hospital. Patients or Participants N/A Interventions We performed a resection of an interstitial ectopic pregnancy hysteroscopically with the aid of laparoscopic visualization. This surgical approach was undertaken after both hysteroscopic and laparoscopic evaluation determined its feasibility. Measurements and Main Results N/A Conclusion Interstitial ectopic pregnancies are rare, and factors such as hemodynamic stability, gestational age, and surgeon expertise must be considered in surgical planning. Hysteroscopic resection of an interstitial pregnancy under laparoscopic guidance can be employed safely in select cases. When appropriate, this technique allows treatment of an ectopic pregnancy with avoidance of more morbid, traditional treatments such as a cornuostomy or cornual wedge resection.

Surgical Management of Interstitial Ectopic Pregnancy

Study Objective To demonstrate a minimally invasive surgical technique for management of interstitial ectopic pregnancy Design N/A Setting Operating room Patients or Participants Patients with interstitial ectopic pregnancy requiring surgical management Interventions Removal of interstitial ectopic pregnancy Measurements and Main Results N/A Conclusion Management of interstitial ectopic pregnancy has traditionally been performed via cornual wedge resection. We present a minimally invasive approach using a four step process: (1) identify the location of the interstitial pregnancy, (2) utilize hemostatic measures such as vasopressin, vessel occlusion, or tranexamic acid, (3) create a circumferential linear incision over the specimen leaving a tissue pedicle, and (4) complete a double layer running closure for re-approximation and hemostasis.

Laparoscopic Management of an Interstitial Ectopic Pregnancy

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.

32: Laparoscopic management of a cornual ectopic pregnancy

The purpose of this video is to demonstrate the technique of laparoscopic management of a cornual ectopic pregnancy. Cornual ectopic pregnancies carry a high risk of catastrophic outcome due to the high vascularity of the area of implantation. Emergent conditions often mandate laparotomy, or conversion to laparotomy, given the fear of hemorrhage and potential difficulty in reapproximating uterine tissue after cornual wedge resection. This is the case of an asymptomatic 34-year-old G2P0 in whom the diagnosis of a right cornual ectopic pregnancy was made by ultrasound, prior to rupture, at 7 weeks 3 days gestation. A right cornual EP was confirmed at the time of laparoscopy. As the video clearly demonstrates, a laparoscopic cornual wedge resection and myometrial re-approximation were carried out without complication. After the case, serial HCG titers were followed until undetectable. No adjuvant methotrexate was necessary. Management of cornual ectopic pregnancy with laparoscopy is a feasible and safe technique in the setting of appropriate preoperative planning and adequate intraoperative surgical proficiency. This video is able to clearly illustrate the salient techniques of a laparoscopic cornual wedge resection.

Robotic Essure® Coil Removal Via Cornual Wedge Resection

Video Objective Describe considerations for pre-operative surgical planning and identify techniques for a cornual wedge resection to adequately remove Essure® coils. Setting A premenopausal female with history of Essure® hysteroscopic sterilization with subsequent development of chronic pelvic pain desiring removal with a uterine sparing procedure. Interventions After confirmation of location and number of Essure® coils by pelvic ultrasound and X-ray, a robotic cornual wedge resection was performed using gentle traction-counter traction, sharp dissection and minimal electrosurgery to remove both fallopian tubes without exposure or fragmentation of the coils. The cornua was then closed with delayed absorbable barbed suture. Conclusion Adequate removal of Essure® coils involve proper pre-operative imaging and complete resection of the tubal interstitium with minimal coil exposure or fragmentation. This prevents breaking or incompletely removing the metallic coils and pro-inflammatory PET fibers.

Interstitial Pregnancies: Tips for Successful Cornual Wedge Resection

Interstitial Pregnancies: Tips for Successful Cornual Wedge Resection

The Ethics of Interstitial and Cesarean Scar Ectopic Pregnancies: Four Case Studies and a Review of the Literature.

Catholic bioethicists have extensively addressed extrauterine tubal pregnancies, which represent the great majority of ectopic pregnancies. However, additional management options have been developed for the other 7-10 percent of ectopic pregnancies. Using two cases of interstitial pregnancy and two cases of cesarean scar pregnancy (CSP) seen at a Catholic tertiary care center, this article discusses options including expectant management, systemic methotrexate, intragestational methotrexate, intragestational potassium chloride, uterine artery embolization, dilation and curettage (D&C), vasopressin use, cornuostomy, cornual wedge resection, CSP evacuation, CSP scar excision, CSP salvage, and hysterectomy. Cornual wedge resection, vasopressin use, and CSP scar excision are morally acceptable; less clearly licit are aspiration of gestational sac contents, cornuostomy, gestational excision for CSPs, and methotrexate. Certainly illicit are any techniques leading to direct abortion such as D&Cs on live embryos or fetuses, double-balloon catheter placement, and use of potassium chloride. Summary: An ectopic pregnancy is any pregnancy outside the uterus. These are dangerous because the pregnancy can burst out of its abnormal location and cause life-threatening internal bleeding. Most are in the part of the fallopian tube outside the uterus, but there are other types, including interstitial pregnancies (located in the part of the tube tunneling through the uterine wall) and cesarean scar pregnancies (buried in the uterine scar where the cut for a C-section was made). This article lists the ways that physicians prevent women from dying from interstitial and cesarean scar pregnancies and proposes which treatments are morally acceptable.

Recurrent Interstitial Pregnancy: a Review of the Literature.

Interstitial pregnancies account for 2-4 % of all ectopic pregnancies. Despite its rarity, various treatment options exist. However, no gold standard has yet been defined and data regarding recurrence of interstitial pregnancies in subsequent pregnancies after different treatments are sparse. This makes it very difficult to provide adequate patient counselling for treatment options with regards to the treatment-related risk of recurrence. The present literature review demonstrates that recurrent interstitial pregnancy is a rare condition and more likely when additional anatomy-related risk factors for ectopic pregnancies are present, such as hydrosalpinges, blocked tubes, endometriosis, fibroids or prior tubal ectopic pregnancies. Therefore, at first appearance and in absence of additional anatomy-related risk factors, methotrexate intravenously, intramuscularly or into the amnion may be the first choice. In case of anatomical risk factors, cornual wedge resection seems to be first choice. In case of recurrence, cornual wedge resection is particularly justified in patients with anatomical alterations of the salpinges. The role of conservative surgical treatments in recurrence as cornuotomy, salpingectomy, endoloop ligation and resection and curettage under laparoscopic guidance remains unclear due to sparse data.

Management options for interstitial ectopic pregnancies: A case series.

Objective:Ectopic pregnancy in the interstitial part of the Fallopian tubes can be life-threatining considering the thin myometrial tissue surrounding the gestational sac and highly vascularization which may result in catastrophic haemorrhage when interstitium is ruptured. The diagnosis and management is challenging. Conservative, medical, and surgical treatment options should be considered based on individual patient factors.Methods:Four women were diagnosed with interstitial pregnancy in last five years in our tertiary center. Four different treatment modalities, including single dose methotrexate, laparotomy, hysteroscopy followed by vacuum aspiration, and vacuum aspiration under laparoscopy were performed according to patients’ characteristics.Results:. Successful outcome was achieved in all patients.Conclusion:Interstitial pregnancy can be successfully treated with a single dose systemic methotrexate when all criteria are met. The classical cornual wedge resection remains lifesaving operation for cases of ruptured interstitial pregnancy. Less invasive procedures such as laparoscopic assisted transcervical vacuum aspiration and diagnostic hysteroscopy followed by vacuum aspiration can be performed in selected cases.