Laparoscopic Surgery For Ectopic Pregnancy Research Articles

Laparoscopic surgery for ectopic pregnancy: A comparative study on the clinical benefits and impact on tubal patency and reproductive outcomes.

Ectopic pregnancy is a major contributor to maternal morbidity and mortality across the globe. This study aims to investigate the clinical benefits of laparoscopic surgery in treating ectopic pregnancy, and its impact on tubal patency and reproductive outcomes. A clinical study was conducted to compare laparoscopic and medical conservative treatment for ectopic pregnancy. A total of 206 patients were treated for ectopic pregnancy at our hospital from January 2018 to June 2020. Among them, 46 underwent laparoscopic ipsilateral salpingectomy, 54 underwent laparoscopic ipsilateral salpingostomy with lesion removal, and 106 were treated conservatively with medication. The age range and average age of each group are provided, with no significant differences in these general demographic characteristics (p> 0.05). Both the salpingostomy and medication groups had higher rates of ectopic pregnancy compared to the salpingectomy group, with statistically significant differences (p< 0.05). The comparison of ectopic pregnancy rates between the salpingostomy and medication groups showed no significant difference. Within three years, the salpingostomy group had 10 cases of recurrent ectopic pregnancy, with 2 cases on the same side, while the medication group had 18 cases, with 8 cases on the same side. At 3 months after the normalization of blood β-HCG, the salpingostomy group showed 43 cases of tubal patency (patency rate: 79.63%), while the medication group showed 57 cases (patency rate: 53.77%), with a statistically significant difference between the two groups (p= 0.01). Laparoscopic surgery for ectopic pregnancy offers significant clinical benefits over conservative medical treatment, including higher rates of tubal patency and improved reproductive outcomes. These findings support laparoscopic surgery as an effective approach for the management of ectopic pregnancy.

Findings from the Use of Spinal Anesthesia in the Laparoscopic Treatment of Extrauterine Pregnancy: Could It Represent an Alternative to General Anesthesia?

Introduction: Minimally invasive procedures performed in laparoscopy, such as salpingectomy for ectopic pregnancy, can be combined with a minimally invasive anesthesia. The aim of this study was to assess the feasibility and the intraoperative and postoperative outcomes of laparoscopic surgery for ectopic pregnancy under spinal anesthesia (SA) compared to general anesthesia (GA) from the point of view of the surgeon, anesthesiologist, and patient. Methods: A retrospective cohort study was performed at DAI Materno Infantile of AOU Federico II of Naples, analyzing all medical records of women who met the inclusion criteria between April 2020 and April 2023. Eighty-two women (35 under SA in group A and 47 under GA in group B) undergone elective or emergency laparoscopic salpingectomy for ectopic tubal or ovarian pregnancy were included. Results: Patients in group A reported less pain at 0 h (adjusted mean difference: −1.5; 95% CI: −2.3 to −0.7; p < 0.001) and after 6 h (adjusted mean difference: −1.1; 95% CI: −2.0 to −0.3; p = 0.01) while no statistically significant differences between the two groups at 12 and 24 h after surgery. No differences were observed among the type of analgesic and during the postoperative observation time, except for paracetamol at 0 h in group B. A faster resumption of bowel motility, patient’s mobilization, and a shorter hospital stay were observed in group A compared to group B. Also greater odds of returning faster to daily activities emerged in group A (adjusted OR: 5.39; 95% CI: 1.77–16.37). A greater number of patients in group A were satisfied with the entire procedure compared to those of group B (33 [94.3%] vs. 37 [78.7%]). The general surgeon satisfaction was always very good or excellent in group A. Finally, all surgical steps were well tolerated in group A. Conclusion: In specific settings, SA is a feasible and safe procedure for the laparoscopic treatment of ectopic pregnancy.

Comparison of Laparotomy and Laparoscopic Surgery for Ectopic Pregnancy at High Altitude

In this paper, by comparing the clinical effects of laparotomy and laparoscopy on the recovery of ectopic pregnancy, 70 patients with ectopic pregnancy in the people's Hospital of Tibet Autonomous region from April 2017 to April 2019 were selected as the control group who received laparotomy. 35 patients in each group were treated by laparoscopy to compare the recovery of the two groups. To solve the problem of which method of operation for ectopic pregnancy in plateau area is better, and to promote the operation for better recovery of patients in the future.

Anesthetic efficacy of propofol combined butorphanol in laparoscopic surgery for ectopic pregnancy: A protocol of systematic review and meta-analysis.

Background:Recent studies have suggested that propofol combined butorphanol (PB) has anesthetic effect in laparoscopic surgery (LS) for ectopic pregnancy (EP). But investigations of its potential effects are inconsistent. We will explore the current literature examining PB in LS for EP.Methods:We will perform a comprehensive search from MEDLINE, Embase, Cochrane Library, PsycINFO, Global Health, Web of Science, Allied and Complementary Medicine Database, and China National Knowledge Infrastructure from inception to the present. Other literatures, such as conference abstracts, references to the relevant reviews will also be checked. Two authors will check the titles, abstracts, and full texts independently. They will also independently carry out data collection and study quality assessment. We will conduct statistical analysis using RevMan 5.3 software.Results:This study will provide accurate results on the anesthetic effect and safety of PB in LS for EP.Conclusion:This study will establish high-quality evidence of the anesthetic effect and safety of PB in LS for EP to facilitate the clinical practice and guideline development.Study registration number:INPLASY202040044.

Morphological changes in the fallopian tubes in patients with ectopic pregnancy

Relevance. Ectopic pregnancy is an urgent condition which may lead to intraabdominal hemorrhage and woman death. In recent years, the frequency of this pathology is significantly increasing. However, morphological changes in the fallopian tubes in patients with this disease remain understudied.&#x0D; Aim. To study morphological changes in the fallopian tubes in patients with ectopic pregnancy with various variants of the clinical course.&#x0D; Materials and methods. The morphological study included 130 patients who had laparoscopic surgery for ectopic pregnancy. Comprehensive morphological study of the fallopian tubes removed during surgery was conducted.&#x0D; Results and discussion. The article presents the morphological changes in the fallopian tubes in patients with ectopic pregnancy. Implantation of a fertilized egg in the fallopian tube led to significant changes in its macro- and microstructure, which were due to invasion of the chorionic villi and involved all layers of the tube wall, differing only in depth and prevalence. The most pronounced morphological changes in various segments of the tube were revealed in the endosalpinx.&#x0D; Conclusion. The combination of morphological changes in different layers of the tube is related to a chronic non-specific productive endomyosalpingitis with luminal deformation, which was one of the main causes of this disease development.

The feasibility and advantages of laparoscopic surgery for ectopic pregnancy at a secondary hospital in South Africa

Background. Ectopic pregnancy (EP) is a gynaecological emergency with implications for maternal morbidity worldwide. Laparoscopic surgery is the preferred method of surgical management in most cases, as it has been shown to improve patient outcomes and overall care and to be cost effective and efficient. Objectives. To investigate the feasibility of laparoscopic surgery for EP management at a secondary hospital, based on incidence rates and comparing surgery-associated variables and outcomes with those in laparotomy. Methods. A retrospective study design was used. All patients who were treated surgically for EP at the Worcester Provincial Hospital were included. The required sample size was 81. Data were collected from patient files and theatre reports. Cases were assigned to one of two cohorts based on the method of surgical management. Results. A total of 84 cases were identified, of which 48 (57.1%) were managed laparoscopically and 36 (42.9%) with laparotomy. The average surgical time was 34.6 minutes and 44.9 minutes for a laparotomy and a laparoscopy, respectively. Patients who were treated laparoscopically required significantly less postoperative pain relief and had shorter hospital stays. Conclusion. This study shows not only that laparoscopy treatment is a feasible option for EP in a secondary-hospital setting in South Africa, but also that the intervention is associated with significantly better patient outcomes than laparotomy. The demonstrated benefits make laparoscopy the preferred treatment modality for EP when surgical intervention is required.

Laparoscopic Management of Cesarean Scar Pregnancy

With the increase in cesarean deliveries worldwide, the reported incidence of cesarean scar pregnancies (CSPs) has increased [ 1 Timor-Tritsch IE Monteagudo A Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol. 2012; 207: 14-29 Abstract Full Text Full Text PDF PubMed Scopus (361) Google Scholar , 2 Gonzalez N Tulandi T Cesarean scar pregnancy: a systematic review. J Minim Invasive Gynecol. 2017; 24: 731-738 Abstract Full Text Full Text PDF PubMed Scopus (108) Google Scholar ]. Among conservative interventions, laparoscopic excision and repair may be an effective option, resulting in immediate recovery and remediation of the cesarean scar defect [ 3 Shao MJ Hu MX Hu M Temporary bilateral uterine artery occlusion combined with vasopressin in control of hemorrhage during laparoscopic management of cesarean scar pregnancies. J Minim Invasive Gynecol. 2013; 20: 205-208 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar , 4 Wang YL Weng SS Huang WC Su TH Laparoscopic management of ectopic pregnancies in unusual locations. Taiwan J Obstet Gynecol. 2014; 53: 466-470 Crossref PubMed Scopus (14) Google Scholar , 5 Jiang S Zhao S Laparoscopic surgery for ectopic pregnancy within a cesarean scar. Clin Exp Obstet Gynecol. 2013; 40: 440-444 PubMed Google Scholar , 6 Wang HY Zhang J Li YN et al. Laparoscopic management of laparoscopy combined with transvaginal management of type II cesarean scar pregnancy. JSLS. 2013; 17: 263-272 Crossref PubMed Scopus (36) Google Scholar , 7 Fuchs N Manoucheri E Verbaan M Einarsson JI Laparoscopic management of extrauterine pregnancy in caesarean section scar: description of a surgical technique and review of the literature. BJOG. 2015; 122: 137-140 Crossref PubMed Scopus (25) Google Scholar , 8 Wang G Liu X Bi F et al. Evaluation of the efficacy of laparoscopic resection for the management of exogenous cesarean scar pregnancy. Fertil Steril. 2014; 101: 1501-1507 Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar ]. We retrospectively reviewed the clinical data of 8 women with CSPs treated in a tertiary medical center between October 2006 and October 2017. The mean gestational age at diagnosis was 6.8 weeks, and fetal cardiac activity was identified in 4 cases.

Effects of WeChat-based continuing nursing in patients after surgery for ectopic pregnancy

Objective To explore the effects of the WeChat-based continuing nursing in patients after surgery for ectopic pregnancy. Methods Totally 280 patients with ectopic pregnancy who received laparoscopic surgery, and then were discharged from Shangqiu First People's Hospital from March 2015 to April 2017 were selected using random sampling and divided into the treatment group (n=140) and the control group (n=140) according to the admission time. Patients in the control group received continuing nursing by outpatient service and telephone follow-up, while patients in the treatment group received the WeChat-based continuing nursing on this basis. The self-designed scale was used to evaluate the patients' awareness of postoperative healthcare and satisfaction with continuing nursing in the two groups. The Exercise of Self-Care Agency (ESCA) Scale was used to assess the patients' self-care ability and compare the difference between the two groups. Results There were significant differences between the two groups in their awareness of ectopic pregnancy-related knowledge, healty lifestyles and dietary habits, postoperative contraception post intervention (P<0.05) ; there were significant differences between the two groups in their self-concept, sense of self-care, self-care skills, health knowledge and the total score three months post intervention (P<0.01) ; and there were significant differences between the two groups in the nurses' question answering, satisfaction of cognitive needs and satisfaction with postoperative care (P<0.01) . Conclusions The WeChat-based continuing nursing can improve the sense of self-care and satisfaction with nursing in patients receiving laparoscopic surgery for ectopic pregnancy, which is worth promoting in clinical practice. Key words: Pregnancy, ectopic; Laparoscopy; Continuing nursing

Carcinoma of unknown primary site and ectopic pregnancy diagnosed at laparoscopic surgery: a rare coexistence

The authors present a case of carcinoma of unknown primary site detected accidentally during laparoscopic surgery for ectopic pregnancy. A 36-year-old female patient (para 1, gravida 1) was referred to the present hospital with suspected ectopic pregnancy. Transvaginal ultrasound showed a right adnexal mass and echo-free space in the pelvic cavity. Her serum human chorionic gonadotropin level was 7,590 mIU/ml. The authors made a preoperative diagnosis of ectopic pregnancy and performed laparoscopic surgery. The ampulla of the right fallopian tube was enlarged and showed blood clotting. They noticed a white solid mass of size 1 cm on the peritoneum around the right pelvic ligament. Pathologic examination findings of the specimen were consistent with carcinoma. Immunohistochemical stains suggested high-grade neuroendocrine carcinoma. Routine metastatic workup could not reveal the original site. The final diagnosis was carcinoma of unknown primary site. The authors reviewed other case reports on neoplasms coexisting with ectopic pregnancy.

Experience of a unit for the pathology of early pregnancy and ectopic pregnancy

Objective: The study was undertaken to evaluate the utility in term of diagnosis, treatment, outcomes and drop out of an ambulatory management of first trimester pathology. Study design: Retrospective review of patients seen in our Early Pregnancy Unit, in Macedonio Melloni Hospital (Milan – Italy) in a period from January 2009 to December 2015 Results: We evaluated a total of 1751 women in childbearing age. The reason of the first access in our ambulatory was: in 112 cases the need of control because an anechoic sac was seen in the uterus but there were not a certain diagnosis of physiological pregnancy. Among these, we diagnosed 23 ectopic pregnancy, 658 miscarriage, 428 intra uterine pregnancy, 8 molar pregnancy. In 271 first access, the reason was an uncertain localization pregnancy. Among these, we diagnosed 131 miscarriage, 53 ectopic pregnancy, 85 intrauterine pregnancy. In 16 patient the reason was a suspected molar pregnancy and we found 6 molar pregnancy, 8 miscarriage, 2 intrauterine pregnancy. 214 patients were referred to our ambulatory for the need of a follow up. Among these, we had in 55 cases a follow up for molar pregnancy, in 59 cases a follow up after medical treatment of ectopic pregnancy with methotrexate, in 19 women a control after laparoscopic surgery for ectopic pregnancy and in 81 patients a control after surgical treatment of miscarriage for some finds, as idropic degeneration of trophoblast, at the istological analysis. In total we were able to perform expectant management for ectopic pregnancy in 23 cases and medical therapy with methotrexate in 117 cases. We had just 2 cases of failure of the conservative medical treatment for ectopic pregnancy, who underwent laparoscopic surgery. The mean time for the diagnosis, calculated from first access to emergency of a symptomatic woman in total absence of a diagnosis to the day of decision about treatment, which means a certain diagnosis, was 10 days (range 1–23 days). The drop out of patients was very low with only 9 cases. Conclusion: For several years, in treating ectopic pregnancy, less frequently the need and the purpose is to save the life of the patient but increasingly it is to preserve her fertility. Diagnosis is often early and, above all, it often takes place before when the haemoperitoneum constitutes a serious life-threatening for the patient. The presence of the Early Pregnancy Unit in our Hospital permitted to perform a conservative treatment in the 47% of all cases of ectopic pregnancy. This result was possible because of an early diagnosis and of a timely treatment with a well organized follow up. It was also possible an accurate differential diagnosis, with simplification of diagnostic and therapeutic path for patients, minimizing urgent surgical therapy and improper hospitalization. Finally, this kind of organization allows accurate data collection and database creation with improve of the scientific research.

The effectiveness of laparoendoscopic single-site surgery (LESS) compared with conventional laparoscopic surgery for ectopic pregnancy with hemoperitoneum

ObjectiveThe purpose of this study was to compare clinical outcomes of conventional laparoscopic surgery and laparoendoscopic single-site surgery (LESS) in the surgical treatment of tubal ectopic pregnancy. Material and methodsA total of 156 patients were diagnosed with ectopic pregnancies by ultrasonography and serum β-human chorionic gonadotrophin (β-hCG) levels at Pusan National University Yangsan Hospital from January 2009 through December 2013. We excluded 28 patients who only received medical treatment, 15 patients who underwent surgery by laparotomy for severe hypovolemic shock, and 30 patients who presented with less than 1 L of hemoperitoneum. Of the 83 patients with massive hemoperitoneum, 38 patients had LESS performed while the remaining 45 patients underwent conventional laparoscopic surgery. ResultsIn this study, there were no statistically significant differences in clinical outcomes in either surgical method except for operative time. Operative time of LESS was significantly shorter than conventional surgery for patients with more than 500 mL of hemoperitoneum. ConclusionLESS is a safe and feasible surgical approach in the treatment of tubal ectopic pregnancy. At the same time, LESS has been shown to be more effective than conventional laparoscopic surgery in handling massive hemoperitoneum of more than 1 L, which is a common complication of ectopic pregnancy.

Implications of perihepatic adhesions in women undergoing laparoscopic surgery for ectopic pregnancy

ObjectiveTo establish whether the finding of perihepatic adhesions (PHAs) at laparoscopy for ectopic pregnancy (EP) is associated with poor perioperative and reproductive outcomes. MethodsA retrospective cohort study was undertaken of all cases of EP managed surgically at a teaching hospital in northeast London in 2003–2013. Data for symptoms, reproductive history, ultrasonography findings, blood parameters, and findings at surgery were compared between patients with and without perihepatic adhesions (PHAs) identified at laparoscopy. ResultsAmong 802 women with EP, PHAs were identified during surgery for 60 (7.5%). Compared with women without PHAs, patients with PHAs were significantly more likely to have had previous pelvic inflammatory disease, previous EP, previous tubal surgery, and the finding of abnormal contralateral adnexa or other adhesions during laparoscopy (P≤0.024 for all). They also had higher preoperative hemoglobin concentrations and smaller hemoperitoneum volumes (P≤0.04 for both). ConclusionWomen with PHAs at laparoscopy for EP had lower blood loss than did those without PHAs. The finding of PHAs was associated with an increased rate of recurrent EP, irrespective of a previous history of PID or EP.

Evaluation of systemic circulation at laparoscopic surgery for ectopic pregnancy

Aim. To study the effect of tension carboxyperitoneum on central circulatory parameters of patients undergoing laparoscopy.Methods. Vascular wall condition, linear blood flow velocity, pulse wave velocity, vascular wall rigidity, general and specific peripheral resistance (by the method of volumetric compression oscillometry) were evaluated. The study included patients with tubal pregnancy undergoing endovideosurgery. In the first group, 76 patients, the operation was performed without introducing carbon dioxide into the abdominal cavity; operational volume has been created using the original retractor of the anterior abdominal wall. In the second group (67 patients), classical technique of laparoscopic surgery with the use of carboxyperitoneum was applied. Measurements of systemic circulatory parameters were performed in patients twice - in the group where no gas was used - before and 15 minutes after introducing laparoscopic devices, in the group of carboxyperitoneum - before and 15 minutes after carbon dioxide introduction.Results. The changes of systemic circulatory parameters were non-significant in patients of the first group and did not lead to statistically significant changes of mean, lateral and systolic blood pressure. Endovideosurgery using carboxyperitoneum lead to systemic circulatory disorders: blood pressure instability, increased cardiac output and index, decreased total peripheral vascular resistance, and the actual and specific peripheral resistance, as well as linear flow velocity and vascular rigidity.Conclusion. Laparoscopic surgery using carbon dioxide are associated with the vessel compression and increased heart load, clinically manifesting as blood pressure disorders.

Prospective comparison of single port versus conventional laparoscopic surgery for ectopic pregnancy.

To investigate the feasibility and safety of single port laparoscopic surgery (SP-LS) for ectopic pregnancy, irrespective of type of ectopic pregnancy and hemodynamic stability. A prospective case-control study of 106 women who underwent SP-LS or conventional LS for a suspected ectopic pregnancy was performed at a university teaching hospital from January 2009 to March 2012. Twenty-six women underwent SP-LS (SP-LS group) and 80 women underwent conventional LS (conventional LS group). There were no statistical differences between the groups in terms of demographic characteristics, operating time, hemoglobin change, return of bowel activity, hospital stay or complication rate. There were no cases of additional trocar use or conversion to laparotomy. Of five women with heterotopic pregnancy, one underwent SP-LS, and three underwent conventional LS for tubal pregnancy, which all resulted in vaginal delivery without obstetric complication; one woman received SP-LS for cornual pregnancy and had an ongoing pregnancy. SP-LS for ectopic pregnancy is feasible and safe regardless of the type of ectopic pregnancy and hemodynamic stability. However, further work is needed to confirm this conclusion and to demonstrate any advantage of SP-LS for ectopic pregnancy.

Evaluation of Postsurgical Pain in Single- Port versus Three-Port Laparoscopic Surgery for Ectopic Pregnancy: A Preliminary Study

Objective: To retrospectively compare the postsurgical pain after single-port laparoscopic surgery and conventional laparoscopic salpingectomy for the surgical treatment of tubal pregnancy. Methods: The cases of two groups of patients with ectopic pregnancies were reviewed: those who had undergone a single-port laparoscopic surgery (n=6) and those who had undergone a conventional multi-port laparoscopic surgery (n=20). We compared these groups’ surgical outcomes, including operative time, blood loss, use of analgesics, and complications. Results: There was no significant difference between the two groups regarding the surgical time, blood loss during surgery, or analgesics use after laparoscopic surgery. There were no serious complications and no need for conversion to conventional laparoscopy or laparotomy in both groups. Conclusion: Our present findings suggest that single-port laparoscopic surgery is feasible and practical for the surgical treatment of ectopic pregnancies. However, the results also indicate that the reduction of the number of laparoscopy ports did not offer further pain relief in these patients.

The utility of intraoperative cell salvage and autologous blood transfusion in two cases of laparoscopic surgery for ectopic pregnancy with a large amount of hemoperitoneum

The utility of intraoperative cell salvage and autologous blood transfusion in two cases of laparoscopic surgery for ectopic pregnancy with a large amount of hemoperitoneum

Is Serum Human Chorionic Gonadotrophin Follow-Up Necessary after Suspected Spillage of Trophoblast at the Time of Laparoscopic Surgery for Ectopic Pregnancy?

Background: Persistent trophoblast is a recognised complication of salpingostomy for the treatment of ectopic pregnancy, with reported rates of 3–20%; hence, women are advised to have serum human chorionic gonadotrophin (hCG) levels monitored post-operatively. Although much less common, there are also reports of disseminated trophoblastic peritoneal implants after laparoscopic salpingectomy. The aim of this study was to assess whether monitoring of post-operative serum hCG levels is necessary in women undergoing salpingectomy, where intra-operative spillage of trophoblast is thought to have occurred. Methods: This was a retrospective study of women who underwent serum hCG follow-up after salpingectomy. Serum hCG levels were monitored if: (1) the ectopic pregnancy was found to be ruptured; (2) there was a significant haemoperitoneum (>500 ml); (3) there was thought to be spillage of trophoblast at the time of salpingectomy or (4) a tubal miscarriage was diagnosed. Serum hCG levels were taken at days 1–2, days 3–4, days 6–8 or days 13–15 post-surgery. Women were followed up until the serum hCG level was <15 IU/l. Persistent trophoblast was defined as a failure of the serum hCG level to decrease spontaneously after surgery. Results: 105 women underwent serum hCG follow-up after a laparoscopy for a tubal ectopic pregnancy. Of these women, 92 had a laparoscopic salpingectomy and 13 were diagnosed with a tubal miscarriage at the time of laparoscopy. In all women the serum hCG decreased spontaneously. Conclusion: It does not appear necessary to routinely monitor serum hCG levels post-operatively in women diagnosed with tubal miscarriages, in those undergoing salpingectomy for a ruptured ectopic pregnancy or in cases of salpingectomy, where there is thought to be spillage of trophoblast.

Omental and peritoneal secondary trophoblastic implantation – an unusual complication after IVF

Omental pregnancy is an uncommon form of abdominal pregnancy; it has never been previously reported after IVF. A 35-year-old patient underwent IVF for tubal factor infertility. The treatment cycle was uneventful, but 3 weeks following embryo transfer the patient was diagnosed with a right tubal ectopic pregnancy on ultrasound. A laparoscopic salpingectomy was performed and the patient was discharged home. Two weeks later, the patient presented with abdominal pain and rising serum β-human chorionic gonadotrophin (β-HCG). A repeat laparoscopy showed omental and peritoneal trophoblastic implants. These were excised laparoscopically and confirmed on histology to be trophoblastic tissue. The HCG returned to <3 IU/l, 1 week post-operatively. This case emphasizes the importance of intra-operative care during laparoscopic surgery for ectopic pregnancy and the need for post-operative surveillance of serum β-HCG. An abdominal pregnancy, though rare, has a seven times higher mortality rate than non-abdominal pregnancies. Early diagnosis and treatment can prevent intra-abdominal haemorrhage, as haemorrhagic shock is the commonest cause of mortality from omental pregnancy.

The evaluation of laparoscopic surgery for ectopic pregnancy resulting from in vitro fertilization and embryo transfer

The evaluation of laparoscopic surgery for ectopic pregnancy resulting from in vitro fertilization and embryo transfer

An evaluation of a laparoscopic ectopic simulation by trainees

Tubal pregnancy is responsible for 8.95% of direct maternal deaths and the incidence is rising. Despite a grade A recommendation from the Royal College of Obstetricians and Gynaecologists (RCOG) that the majority of ectopic pregnancies should be managed via the laparoscopic approach, in only 13% of hospitals does this happen routinely. As a reason for this, trainees cite the inability to consolidate and practise the techniques learnt on approved courses well enough to have the confidence to undertake procedures on their own.A highly realistic training simulation, simple and cheap enough to be available in every gynaecological unit, would allow trainees to practise skills learnt on RCOG‐accredited courses on returning to their own hospitals. This would complement supervised training on live patients. Ectopic pregnancy often presents as an emergency, out of hours, when RCOG‐accredited preceptors are unavailable to take juniors through the laparoscopic approach. The simulation would be ready for use at all times.Limbs &amp; Things (Bristol, UK), a company with acknowledged expertise in the development and construction of medical simulations, has developed an ectopic pregnancy simulation, in collaboration with two RCOG‐accredited level 3 minimal access surgeons with experience in training in laparoscopic surgery for ectopic pregnancy. Special attention has been given to the achievement of a realistic appearance and fabrication of a material with the potential to allow monopolar and bipolar diathermy. The simulation was evaluated by 52 trainees of different grades and levels of experience in minimal access surgery (MAS), at the National Trainees' Meeting in Obstetrics and Gynaecology, May 1999. Assessment was done, using visual analogue scores, for realism in appearance, cutting, dissection and diathermy, after trainees had performed a standardized exercise directed by a tutor.Overall, 51 trainees felt this was a valuable exercise in training (98%), and the combined realism score of the simulation was 64.7% (range 40–85%) (SD 13.85%). The MAS level 3 group scored the simulation much more highly at 78.75%, and showed much more consistency (range 75–85%) (SD 2.67%). All members of this group had previously used ectopic simulations, compared with 73% in the level 2 group and 42% in the level 1 group. The level 3 surgeons were not necessarily the most senior grades: 47% were specialist registrar grade 3 (SpR3) or less. Of the senior grades SpR4 and SpR5, 11 of 19 (58%) felt unable to perform laparoscopic salpingectomy with independent competence.The level 3 trainees demonstrated themselves to be the only discerning group able to consistently score the simulation; they assessed the realism highly and felt this could be a valuable method for training in laparoscopic ectopic surgery. Despite RCOG recommendations that all trainees should be independently able to perform salpingectomy and salpingotomy, only 42% of years 4 and 5 were able to do so. The advantages of the laparoscopic approach are accepted. We have demonstrated a need for the necessary training and assessed an effective method for providing this. The system is cheap, and utilizes the equipment already present in all hospitals. We commend the this laparoscopic ectopic training simulation as a possible practicable adjunct to widespread training in laparoscopic ectopic surgery.