Laparoscopic Surgery For Ectopic Pregnancy Research Articles

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The availability of training in the laparoscopic management of ectopic pregnancy

ObjectiveTo assess the availability of laparoscopic treatment for ectopic pregnancy, and the availability of training in such laparoscopic techniques, in the Yorkshire Deanery (training region).DesignA postal questionnaire was distributed to all trainees in the Yorkshire Deanery with a national or visiting training number (denoting eligibility for CCST).Results60 trainees were identified of whom 59 (98%) returned completed questionnaires. Whilst the majority of trainees had observed or assisted with laparoscopic surgery for ectopic pregnancy in their current hospital, only 37% had performed such surgery themselves and only 36% considered that they would be able to achieve appropriate training at that hospital. One or more consultants were offering laparoscopic treatment for ectopic pregnancy in 13 out of the 15 hospitals in the deanery. However, in only five of these hospitals did the majority of trainees consider that they would be able to achieve appropriate training in these techniques.ConclusionAlthough the majority of hospitals have at least one consultant able to undertake laparoscopic surgery for the management of ectopic pregnancy, this is not being translated into a routinely available service or into training opportunities for specialist registrars in the Yorkshire Deanery.

Towards the modern management of ectopic pregnancy: a complete audit cycle of practice in a London teaching hospital

We carried out a complete audit cycle of the management of ectopic pregnancy at a London teaching hospital over 2 years. Case notes of women presenting to St George's Hospital, London in 1995 with ectopic pregnancy were examined and management was assessed. The targets were low rates of rupture, high rates of sonographic diagnosis of ectopic pregnancy, acceptable rates of tubal conservation and laparoscopic surgery. We also considered levels of training of junior doctors in laparoscopic surgery for ectopic pregnancy and the acceptable duration of hospital stay for patients. Recommendations were made, the standards were modified, and the audit repeated for the year 1996. A substantial improvement in the quality of care of women with ectopic pregnancy was achieved. The main improvement was in the ultrasonographic diagnosis of ectopic pregnancy. There was also a reduction in ectopic pregnancies which were ruptured, possibly due to earlier diagnosis. The percentage of cases treated laparoscopically remained stable. More junior doctors performed laparoscopic surgery for the condition. Finally, we confirmed that laparoscopic management of ectopic pregnancy significantly reduces duration of hospital stay, conferring advantages to both patient and hospital.

Intraoperative autologous blood transfusion in laparoscopic surgery for ectopic pregnancy

Objective Our purpose was to evaluate the safety, efficacy and procedural difficulties of intraoperative autologous blood transfusion during laparoscopic surgery for ectopic pregnancy. Design A retrospective study was performed. Methods The Cell Saver, an intraoperative autologous blood salvage device, was used in laparoscopic operations on 13 patients with ectopic pregnancy, who had haemoperitoneum but good physical status without severe anaemia and hypovolaemic shock. Results Homologous blood transfusion was not needed in any patient. The mean blood loss was 327±178 ml and the mean volume of reinfused processed blood was 288±92 ml. The haemoglobin level of reinfused processed blood was proportional to the blood loss. Neither adverse reactions to norprocedural difficulties of autotransfusion were observed. Conclusions When laparoscopic surgery is performed for ectopic pregnancy in patients with haemoperitoneum, intraoperative autologous transfusion employing the Cell Saver is considered to be a potentially very useful technique.

Pregnancy: Operative laparoscopy for ectopic pregnancy: how experienced should the surgeon be?

The purpose of this study was to assess the efficacy of laparoscopic surgery for ectopic pregnancy in a general hospital in Paris, where most of the surgeons are still in training. During a period of 20 months, 100 cases of ectopic pregnancy were diagnosed and treated by the attending residents. Nine cases required a laparotomy due to heavy bleeding or interstitial ectopic pregnancy. Most of the other cases were treated laparoscopically, with either salpingectomy (70 cases) or linear salpingostomy (19 cases). Complications of the laparoscopic surgical procedures were rare. There was one failure of linear salpingostomy that required a second intervention (5.3% failure rate); there was one case of urinary retention that resolved after 48 h; and one case of fever above 38 degrees C that responded well to antimicrobial therapy. In conclusion, we have shown that the current notion that laparoscopic surgery is preferred to conventional abdominal surgery for the treatment of ectopic pregnancy, can be applied to a public gynaecological centre with young inexperienced residents, supervised by experienced gynaecologists.

Fertility outcome after conservative surgical treatment of ectopic pregnancy evaluated in a randomized trial

To evaluate the fertility outcome after laparoscopic surgery for ectopic pregnancy. A randomized trial versus laparotomy was performed between May 1987 and June 1989. The study was conducted in a clinical university center, the Sahlgrens Hospital. A group of 105 patients with tubal pregnancy were stratified with regard to risk determinants and age and randomized to laparoscopy or laparotomy. Eighty-seven patients who desired pregnancy were evaluated for subsequent fertility outcome. Linear salpingotomy was performed in both surgical groups. We evaluated the fertility outcome after laparoscopic salpingotomy for comparison with the outcome after laparotomy. There was no difference between the groups in the overall fertility outcome. A substantially higher proportion of patients in the laparotomy group were subjected to adhesiolysis performed at a second-look laparoscopy. The fertility prospects are not impaired by laparoscopic surgery. Adhesiolysis at a second-look laparoscopy, especially after laparotomy, might be beneficial in selected cases and may serve to improve subsequent fertility.

Nonlaser Videolaparoscopic Surgery for Ectopic Gestation

The potential of nonlaser videolaparoscopic surgery for ectopic gestation in a metropolitan public hospital was assessed by the review of the last 16 consecutive women presenting to the author with either a ruptured or an unruptured ectopic pregnancy. Ten of the 16 were treated by the videolaparoscopic techniques of either salpingotomy or aquaexpression, removal of the ectopic pregnancy and pelvic lavage; there were no intra or postoperative complications. HCG levels were monitored to extinction in all but one woman who had a coexistent intrauterine pregnancy. Three of the 10 women have subsequently had intrauterine conceptions and none have had further ectopic gestations. Those women unsuitable for videolaparoscopic therapy had substantial haemorrhage (4), an ovarian ectopic pregnancy (1) and extensive adhesions precluding laparoscopy (1). The techniques of nonlaser videolaparoscopic treatment for tubal ectopic gestation are simple and appropriate in a majority of women presenting with this condition.