Management Of Cornual Ectopic Pregnancy 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.

Vasopressin Injection Purse-String Ectopic Resection (VIPER) Technique for Laparoscopic Management of Cornual Ectopic

<h3>Study Objective</h3> To describe the VIPER technique for the laparoscopic management of cornual ectopic pregnancy; a technique that minimizes blood loss and mitigates risk of conversion to laparotomy. <h3>Design</h3> Case series. <h3>Setting</h3> High-volume, academic and academic-affiliated medical centers. <h3>Patients or Participants</h3> All patients presenting with cornual ectopic pregnancy managed surgically. <h3>Interventions</h3> Laparoscopic cornual resection by five Minimally Invasive Gynecologic Surgeons. The VIPER technique utilizes four ports (umbilical, left lower quadrant, and ipsilateral right sided) and a 30-degree laparoscope. After obtaining visualization, dilute vasopressin is injected into the myometrium adjacent to the pregnancy. The affected fallopian tube is disconnected distally. A purse-string stitch with uni-directional barbed suture is placed circumferentially around the pregnancy and cinched. This stitch achieves hemostasis regardless of rupture status. The needle is left attached, and a wedge resection of the cornua is performed with an ultrasonic device. The myometrial defect is repaired with the remaining suture. <h3>Measurements and Main Results</h3> 17 patients underwent laparoscopic cornuectomy between 2012 to 2022, with 7 found to be ruptured. The mean patient age was 30 years (range 20-41), mean body mass index was 31.4kg/m² (range 22-52), and mean gestational age was 8 weeks 6 days (range 5 weeks 6 days to 11 weeks 1 day). Patient risk factors included history of prior sexually transmitted infection (3 patients), in vitro fertilization (1 patient), and prior ectopic pregnancy (1 patient). The other twelve patients had no risk factors. The mean operative time was 107 minutes (range 50-229), with mean estimated blood loss of 41mL for non-ruptured and 412mL for ruptured ectopic pregnancies. The mean hemoperitoneum identified was 1117mL, (range 50mL to 3325mL). There were no conversions to laparotomy. 70.6% of patients were discharged on the day of surgery. <h3>Conclusion</h3> The VIPER technique is feasible and effective for the management of both non-ruptured and ruptured cornual ectopic pregnancy.

95 Laparoscopic management of cornual ectopic pregnancy; a review of surgical practice and resection techniques

Introduction: Cornual pregnancies are rare representing approximately 2-4% of all tubal pregnancies however is associated with higher morbidity and mortality risk due to a higher bleeding risk if there is rupture (1). Cornual ectopic pregnancies due to higher bleeding risk and are more commonly managed with corneal resection at laparotomy or even hysterectomy. There have been recent changes in management with cases being managed with methotrexate or laparoscopic resection using new innovative techniques.

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.

2576 Right Sided Cornual Ectopic Pregnancy after Right Salpingectomy

Video Objective To present our experience of laparoscopic management of cornual ectopic pregnancy. Setting Tulip Multispeciality Hospital. Interventions Laparoscopic surgery as a treatment modality for cornual pregnancy. Laparoscopic wedge resection was carried out for corneal pregnancy. A circumferential incision was made above the base of the cornual pregnancy thus leaving behind sufficient serosal and myometrial tissue for closure with minimal distortion to the uterus. After extirpation of the cornual pregnancy, the myometrial defect was reconstituted with Vicryl 1-0 in two layers. Hemostasis was achieved by suturing. Conclusion We have to be aware that conual pregnancy can be presented even after salpingectomy and laparoscopic approach for cornual ectopic is minimally invasive, safe procedure if performed by a confident and experienced surgeon. To present our experience of laparoscopic management of cornual ectopic pregnancy. Tulip Multispeciality Hospital. Laparoscopic surgery as a treatment modality for cornual pregnancy. Laparoscopic wedge resection was carried out for corneal pregnancy. A circumferential incision was made above the base of the cornual pregnancy thus leaving behind sufficient serosal and myometrial tissue for closure with minimal distortion to the uterus. After extirpation of the cornual pregnancy, the myometrial defect was reconstituted with Vicryl 1-0 in two layers. Hemostasis was achieved by suturing. We have to be aware that conual pregnancy can be presented even after salpingectomy and laparoscopic approach for cornual ectopic is minimally invasive, safe procedure if performed by a confident and experienced surgeon.

Management of Cornual Ectopic Pregnancy with Previous Cesarean Section and Chronic Pelvic Inflammatory Disease

Management of Cornual Ectopic Pregnancy with Previous Cesarean Section and Chronic Pelvic Inflammatory Disease

Technique for the Laparoscopic Management of a Cornual Ectopic Pregnancy

Study ObjectiveTo describe a technique for the laparoscopic management of a cornual ectopic pregnancy. DesignStep-by-step explanation of the procedure using video (Canadian Task Force classification III). SettingCornual pregnancy is a rare form of ectopic pregnancy, accounting for up to 2% to 4% of all ectopic pregnancies, with a mortality range of 2.0% to 2.5%, and this accounts for 20% of all deaths caused by ectopic pregnancies. Both medical and surgical treatments have been reported. Although laparotomy hysterectomy and cornuectomy used to be the preferred surgical approaches, more cornual ectopic pregnancies are being managed with the laparoscopic approach through cornuostomy or cornuectomy in recent years. The main concern with surgical treatment is hemorrhage and the need for cornual reconstruction, which necessitate advanced laparoscopic skills and technique. InterventionsIn this video, we describe our technique for the treatment of a cornual ectopic pregnancy. We present the case of a 21-year-old G3P2002 (gravida 3 para 2002) with the finding of a right live cornual ectopic pregnancy with gestational age of 6 weeks on pelvic ultrasound along with an elevated human chorionic gonadotropin level at 7,192 and right pelvic pain. After counseling regarding treatment options, the patient agreed with proceeding with surgery and underwent a laparoscopic right cornuectomy. Her surgery was uneventful, and she was discharged home a few hours after surgery. She was completely recovered at her postoperative follow-up visit. Her serial serum human chorionic gonadotropin levels were followed until complete resolution a few weeks later. ConclusionLaparoscopic cornuectomy is a safe and effective procedure for the management of cornual ectopic pregnancy. The use of hemostatic agents and suturing can help prevent hemorrhage and allows a safe removal of the ectopic pregnancy and repair of the uterine defect created.

Diagnosis and laparoscopic management of 11 consecutive cases of cornual ectopic pregnancy

To determine the pre-operative diagnosis by two dimensional ultrasound scan and the outcome of the laparoscopic management of cornual ectopic pregnancy. Prospective database cohort study. Whipps Cross University Hospital, UK (District General Hospital). Eleven patients with cornual ectopic pregnancy presenting in our hospital between January 2003 and December 2007. Laparoscopic cornuostomy or cornual resection. Pre-operative diagnosis by ultrasound scan, conversion rate to laparotomy, successful laparoscopy (not requiring further treatment), complication rate and duration of hospital stay. The mean gestational age was 8 +/- 2 weeks. All 11 patients presented with abdominal pain and vaginal bleeding and two (18%) patients became haemodynamically unstable before laparoscopy. There were five (45%) patients with risk factors for ectopic pregnancy. The mean serum beta-human chorionic gonadotropin (beta-hcg) was 15,263 +/- 12,045 microm/ml. One patient did not have a transvaginal scan as it was decided to proceed to surgery on clinical grounds. The diagnosis of ectopic pregnancy was correct at initial scan in nine (90%) of the ten patients who had transvaginal scans as one patient was misdiagnosed at the first scan. However, an ectopic pregnancy was diagnosed on a second ultrasound scan assessment. Initial laparoscopy was negative in one of the nine patients diagnosed as having an ectopic pregnancy. The diagnosis was later confirmed following serial serum beta-hcg monitoring, a repeat scan and a second laparoscopy. Ten (91%) of the 11 patients had successful operative laparoscopy as one (9%) patient had conversion to laparotomy. Among patients who had laparoscopic surgery, cornuostomy was performed in three (30%) patients while cornual resection was performed in the other seven (70%) patients. One (10%) of the patients who had laparoscopic surgery needed further treatment with systemic methotrexate. This patient had a cornual resection and was the only complication following laparoscopic surgery. The mean hospital stay was 2 days. This presentation of one of the larger series of patients with cornual ectopic pregnancy managed by laparoscopic surgery reveals that experience at ultrasonography and laparoscopic technique can lead to earlier diagnosis and few cases requiring laparotomy or further treatment. In addition laparoscopic surgery for cornual ectopic is safe and lends itself to conservative approach (cornuostomy) in selected cases.

241: A Novel Endoscopic Surgical Technique: Ultrasound and Laparoscopic-Guided Evacuation of Cornual Pregnancy

We present a novel endoscopic management of cornual ectopic pregnancy, which is associated with lesser morbidity, and lesser likelihood of affecting future fertility. We report trans-cervical evacuation of the cornual ectopic under intra-operative ultrasound and laparoscopic guidance.

The Outcome of Medical Management of Cornual Ectopic Pregnancy: Two Case Reports

DOI: http://dx.doi.org/10.3126/njog.v4i2.5048 NJOG 2010 Jan-Feb; 4(2): 51-53