Repeat Laparoscopy Research Articles

Laparoscopic Obliteration of the Nephrosplenic Space Using Polypropylene Mesh in Five Horses

To report a laparoscopic technique for insertion of polypropylene mesh in the nephrosplenic space in horses and evaluate outcome. Descriptive experimental study. Five healthy mature horses. One laparoscope and 2 instrument portals were made on the left side of the horse. The nephrosplenic space was measured and appropriately sized polypropylene mesh was inserted and attached to the dorsolateral splenic capsule and perirenal fascia using helical titanium coils. All horses had repeat laparoscopy 4 weeks later and were necropsied at intervals 4-14 weeks after mesh placement. Mean time for laparoscopic mesh placement was 104 minutes. None of the horses had signs of colic and at 4 weeks all mesh implants were covered by fibrous tissue. One horse had a descending colon mesenteric adhesion to the mesh. At necropsy, the fibrous tissue covering the mesh had adhered to itself and pulled the splenic capsule and perirenal fascia into close apposition. Each mesh implant was firmly adhered to the spleen, nephrosplenic ligament, and perirenal fascia. Laparoscopic mesh placement was easily performed, well tolerated, and provided excellent fibrous obliteration of the nephrosplenic space. The single important complication observed was a mesenteric adhesion of the descending colon to the mesh in 1 horse. Laparoscopic placement of polypropylene mesh leads to obliteration of the nephrosplenic space within 4 weeks and should prevent entrapment of viscera in the nephrosplenic space.

Multiple peritoneal parasitic myomas after laparoscopic myomectomy and morcellation

We describe multiple parasitic myomas visualized on laparoscopy in a woman who had a previous laparoscopic myomectomy. Location of the myomas suggests morcellation as a contributing factor.

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.

Pelvic meningocele can be missed during laparoscopy

Pelvic meningocele is an uncommon condition and is frequently asymptomatic. The diagnosis easily can be mistaken as ovarian cyst on pelvic sonography. In many reported cases, the diagnosis was made during laparotomy for presumed ovarian cysts. Myelography, computerized tomography (CT), or magnetic resonance imaging (MRI) is useful for definitive diagnosis. A 49-year-old woman, who had a normal diagnostic laparoscopy 3 years prior, was referred for a persistent ovarian cyst. Repeat laparoscopy revealed a retroperitoneal cyst in the left pelvic sidewall. Both ovaries and fallopian tubes were normal. Subsequent CT and MRI were used to diagnose pelvic meningocele. We speculate that pelvic meningoceles can be missed during laparoscopy due to the increased intraperitoneal pressure and the potential reduction in the cerebrospinal fluid pressure at the lumbosacral level.

Laparoscopic Ovariectomy in Mares Using a Polyamide Tie‐Rap

To describe use of a polyamide tie-rap to ligate the mesovarium during standing laparoscopic ovariectomy in mares. Prospective study. Ten mares. Bilateral ovariectomy was performed in 10 mares. Standing laparoscopic ovariectomy was performed using 3 portals in the paralumbar fossa. A commercial polyamide tie-rap was prepared as a loop and marked with 4 colored lines close to the buckle, to enable us to check whether the loop was tightened securely. The ovary was grasped with forceps and after the mesovarium was minimally transected cranially and caudally, the loop of the tie-rap was inserted in the abdomen and placed around the mesovarium. It was firmly tightened, until at least 3 of the 4 marks were visible, then the end of the tie-rap was cut. The ovary was transected and removed through an enlarged 3rd portal. The contralateral ovary was removed similarly through the opposite paralumbar fossa. Repeat laparoscopy was performed in 8 mares, 2, 3, 4, and 12 weeks later. None of the mares had postoperative discomfort. On repeat laparoscopy, there was complete encapsulation of the stump and tie-rap after 3-4 weeks. In 2 mares, an adhesion between the left stump and the mesentery of the descending colon was observed. Ligation of the mesovarium can be easily and safely performed using a polyamide tie-rap during standing laparoscopic ovariectomy in mares. Standing laparoscopic ovariectomy using a polyamide tie-rap is a safe, technically easy and reliable surgical procedure in the mare.

Evaluation of a new surgical approach for the treatment of clomiphene citrate-resistant infertility in polycystic ovary syndrome: Laparoscopic ovarian multi-needle intervention

Laparoscopic ovarian drilling (LOD) is the accepted second-line treatment for clomiphene citrate-resistant anovulatory infertility in polycystic ovary syndrome (PCOS). Although multiple pregnancy rates are reduced with ovarian drilling procedures, postoperative adhesion formation is a potential complication in up to 85% of the women subjected to laparoscopic destructive ovarian procedures. Our objective was to determine the effectiveness of a new, specially designed laparoscopic device and technique that might enable treatment for patients with anovulatory PCOS with less trauma and fewer postoperative adhesions. Thirty-five infertile clomiphene citrate-resistant women with PCOS were included. Seventeen women underwent laparoscopic ovarian multi-needle intervention (LOMNI), and 18 women received step-up ovulation induction treatment with recombinant follicle-stimulating hormone followed by intrauterine insemination for three cycles. Patients were followed for a period of 6 months after either laparoscopic surgery or the initiation of ovulation induction therapy. Outcome measures were cycle regularity, pregnancy rate, safety, postoperative adhesion formation, and cost effectiveness. There were no significant differences between the two groups in terms of age, body-mass index, duration of infertility, and basal cycle-day 2 hormone levels. Significant improvement in cycle regularity (p <.01) was found after LOMNI. Cumulative pregnancy rates (35.3% in the LOMNI group vs 33.3% in the ovulation induction group) did not differ between the groups. No adverse events following surgery were noted. Moderate ovarian hyperstimulation syndrome and multiple pregnancies occurred in four and two patients, respectively, in the ovulation induction group. Eight nonpregnant women in the LOMNI group underwent repeat laparoscopy at the end of the follow-up period. No adhesion formation attributable to LOMNI was observed in any of those eight women. The cost of LOMNI was significantly (p <.001) lower than the ovulation induction treatment. In conclusion, LOMNI may be a safe, inexpensive, and effective procedure for the treatment of CC-resistant infertility in patients with PCOS. It seems to preserve the beneficial effects and probably omits unwanted effects (such as adhesion formation) of LOD.

Evaluation of a Sheep Laparoscopic Uterine Trauma Model and Repeat Laparoscopy for Evaluation of Adhesion Formation and Prevention with Sodium Carboxymethylcellulose

To evaluate topical application of 1% sodium carboxymethyl cellulose (SCMC) for prevention of postoperative adhesions in a laparoscopic model of uterine trauma in sheep. Experimental study. Fourteen non-pregnant ewes. Ewes were randomly assigned to 1 of 2 groups: control (saline solution) or 1% SCMC treatment. By left flank laparoscopy, traumatic forceps were used to create serosal trauma (1.5 x 5 cm) and hemorrhage on the left uterine horn. Either 30 mL saline solution or 30 mL 1% SCMC was applied topically to the traumatized uterine horn. Adhesion formation was evaluated by repeat laparoscopy at days 14 and 21. Sheep were euthanatized on day 28 for necropsy evaluation of adhesions. Five control sheep had adhesions of the uterine horn by day 14, but only 4 had adhesions at day 21, and 2 at day 28. Adhesions did not occur in SCMC-treated sheep. No adhesions occurred elsewhere in the abdomen. Laparoscopically created uterine trauma is an effective method for induction of uterine adhesions, and laparoscopy is an excellent method for serial evaluation of adhesion formation. SCMC (1%) was effective at preventing adhesion formation in sheep and no inflammatory response was noted. SCMC (1%) should be considered for prevention of adhesions in abdominal surgery in sheep.

Laparoscopic excision of endometriosis: A randomized, placebo-controlled trial

To examine the effect on pain and quality of life for women with all stages of endometriosis undergoing laparoscopic surgery compared with placebo surgery. A randomized, blinded, crossover study. A tertiary referral unit in a district general hospital. Thirty-nine women with histologically proven endometriosis completed the 12-month study. Women were randomized to receive initially either a diagnostic procedure (the delayed surgical group) or full excisional surgery (the immediate surgery group). After 6 months, repeat laparoscopy was performed, with removal of any pathology present. The end points were changes from baseline values of visual analogue pain scores, validated quality-of-life instruments (EQ-5D and SF-12), and sexual activity questionnaire scores. Patients and assessors of outcomes were blinded to the treatment-group assignment. Significantly more of the 39 women operated on according to protocol reported symptomatic improvement after excisional surgery than after placebo: 16 of 20 (80%) vs. 6 of 19 (32%); chi(2)(1) = 9.3. Other aspects of quality of life were also significantly improved 6 months after excisional surgery but not after placebo. Progression of disease at second surgery was demonstrated for women having only an initial diagnostic procedure in 45% of cases, with disease remaining static in 33% and improving in 22% of cases. Nonresponsiveness to surgery was reported in 20% of cases. Laparoscopic excision of endometriosis is more effective than placebo at reducing pain and improving quality of life. Surgery is associated with a 30% placebo response rate that is not dependent on severity of disease. Approximately 20% of women do not report an improvement after surgery for endometriosis.

Frequency and Laparoscopic Management of Ovarian Remnant Syndrome

Study Objective To report the frequency and outcome of laparoscopy in women with chronic pelvic pain and/or pelvic mass who were found to have ovarian remnants. Design Cohort study. (Canadian Task Force classification II-2). Setting University-affiliated hospital. Patients One hundred nineteen women who had had hysterectomy and oophorectomy. Intervention Laparoscopic surgery. Measurements and Main Results Ovarian remnants were known in 5 and were found intraoperatively in 21 patients (18%). These 26 women had undergone at least one laparoscopy in an attempt to remove the remnants. After the ureter was identified, ovarian remnants were dissected and removed from the retroperitoneum laparoscopically with minimal risk of vessel or visceral injury. There were no intraoperative or postoperative complications and no conversions to laparotomy. In addition to ovarian remnants, adhesions were found in 19 women, endometriosis in 4, and no other pathology in 3. Twenty women had complete relief of symptoms. At follow-up of 1 to 8 years (mean 5 yrs), six underwent repeat laparoscopy for persistent pain; one had recurrent ovarian remnant. Conclusion Ovarian remnant syndrome is not an infrequent complication after hysterectomy and oophorectomy in women with endometriosis.

Results after laparoscopic lysis of adhesions and placement of seprafilm for intractable abdominal pain.

The surgical treatment of patients with chronic abdominal pain resulting from intraabdominal adhesions is controversial. We report our experience with treatment of this challenging patient population using laparoscopic lysis of adhesions (LOA) and placement of Seprafilm (Genzyme, Cambridge, MA, USA). The participants in this study were 19 consecutive patients (2 men and 17 women) who underwent laparoscopic LOA and placement of Seprafilm between July 1998 and July 2001. Patients with abdominal pain resulting from irritable bowel syndrome, hernias, or endometriosis were excluded. The patients had undergone a mean of 6.4 previous abdominal procedures (range, 1-14) and 2.3 previous LOAs (range, 0-10). They had experienced chronic, intractable abdominal pain for at least 4 months (range, 4-180). Eight patients had preoperative obstructive symptoms. A completely laparoscopic procedure was used to treat 16 patients, whereas the procedure for 3 patients was converted to open surgery because of dense adhesions. Perioperative complications included two patients in whom enterocutaneous fistulae developed and one patient with intraabdominal hematoma. At follow-up (mean, 9.6 months; range, 1-32 months), 14 patients (73.7%) had completely discontinued all pain medications. At this writing, 12 of these patients are completely symptom free. Two patients are taking nonsteroidal antiinflammatory drugs (NSAIDs) as needed, and three patients require round-the-clock narcotics. Three patients were readmitted with small bowel obstruction, which was managed nonoperatively. One patient had diagnostic laparoscopy for recurrent pain 6 months postoperatively, but had no adhesions. Chronic intractable abdominal pain is relieved in most patients via this approach. Repeat laparoscopy in two patients showed no intraabdominal adhesions. Laparoscopic LOA and placement of Seprafilm is an excellent approach to this challenging patient population with symptoms caused by intraabdominal adhesions.

Peritoneal defects and the development of endometriosis in relation to the timing of endoscopic surgery during the menstrual cycle

Objective: In vitro studies demonstrated that implantation on membranes (peritoneum, amniotic membranes) can take place if there are defects on the surface of the membranes. If these mechanisms play a role for the development of endometriosis in vivo, then patients with surgical treatment of peritoneal endometriosis in the luteal phase must have a high recurrence rate. Design: Retrospective analysis of operation charts and follow-up data. Setting: Department of gynecology, in a hospital-based endometriosis treatment center. Patient(s): Two hundred twenty premenopausal women. Intervention(s): Laparoscopic treatment for peritoneal endometriosis, stage I and II by revised American Society for Reproductive Medicine guidelines. Main Outcome Measure(s): During the follow-up period of 2 years, symptoms and gynecological and sonographic findings were documented. In case of suspected recurrence a repeat laparoscopy with biopsy was performed to prove the recurrent endometriosis macroscopically and histologically. Result(s): The total recurrence rate after 2 years was 9.6%. The recurrence rate of group III (15%) was twice as high as those of group I (7%) and group II (8%), as indicated by subjective complaints, clinical findings, macroscopy, and histology; no differences were found between groups I and II. Conclusion(s): Endoscopic surgery for the treatment of peritoneal endometriosis should not be performed in the luteal phase.

Laparoscopic repair of ventral incisional hernia.

Laparoscopic repair of ventral incisional hernias was first reported in 1993. Since then, there have been sporadic case reports and small series published about this procedure, but it has not been widely adopted. Newer types of composite prosthetic mesh may reduce the potential problem of bowel adhesion. Thirty cases of laparoscopic ventral incisional hernia repairs (carried out by two surgeons or their senior registrars) have been retrospectively reviewed and reported in this article. The data were obtained from patient records and subsequent phone surveys. Thirty patients between 29 and 82 years (mean: 58 years) underwent this procedure. There were 14 men and 16 women. The average weight of the patients was 81 kg. The hernias were up to 6 or 7 cm in diameter. Mesh was used in 28 cases (polypropylene in 25 cases, expanded polytetrafluoroethylene in two cases and composite mesh in one case). Most meshes were laid intraperitoneally and fixed into position with laparoscopic spiral tacks. Twenty-nine cases were completed laparoscopically. One operation (3.3%) was converted to an open procedure because of severe bowel adherence to the hernia sac. The mean operating time was 52 min for laparoscopic ventral incisional hernia repairs only. All but two patients tolerated an oral diet within 24 h. The postoperative hospital stay ranged from 0 to 11 days, with 17 patients (57%) staying overnight and eight patients (27%) staying another day. Over 80% of the patients returned to house duties within a week. There was no mortality, and minor complications occurred in four patients (14%). One patient had a small bowel obstruction treated successfully by repeat laparoscopy with division of fibrinous adhesions to polypropylene mesh on day four. Follow up ranged from 1 to 69 months (mean: 12 months). One patient did not attend follow-up appointments. There were three cases of hernia recurrence (10%). The results suggest that laparoscopic repair of ventral incisional hernias is a safe, effective and technically feasible operation for small- to medium-sized hernias allowing shorter hospital stay, early recovery and resumption of normal activities. However, recurrence rates are comparable to open mesh hernioplasty especially for larger hernias.

Laparoscopic closure of the renosplenic space in standing horses.

To report a technique for laparoscopic ablation of the renosplenic space in standing horses. Development of a technique to perform laparoscopic renosplenic space ablation in standing horses. Five healthy horses, aged 3 to 13 years, weighing 380 to 520 kg. Horses were restrained in standing stocks and sedated with detomidine (0.01 mg/kg intravenously [IV]) and butorphanol (0.01 mg/kg IV). Portal sites in the left paralumbar fossa were infiltrated with 2% mepivacaine. A laparoscopic portal was placed between the 17th and the 18th ribs. Two instrument portals were located caudal to the 18th rib. Closure of the renosplenic space was accomplished by apposing the dorsomedial splenic capsule to the dorsal portion of the renosplenic ligament with 1 polyglactin 910 in a continuous pattern. All horses had repeat laparoscopy 3 weeks after initial surgery. Laparoscopic closure of the renosplenic space required 35 minutes (range, 20-65 minutes) and was successful without intraoperative or postoperative complications. On laparoscopic re-examination at 3 weeks, there was smooth connecting fibrous-like tissue between the dorsal splenic capsule and the dorsal portion of the renosplenic ligament. Laparoscopic closure of the renosplenic space can be efficiently and safely performed in standing horses. Laparoscopic-assisted closure of the renosplenic space can be performed in standing horses and may be useful in preventing recurrent incarceration of viscera in this space.

Sclerotherapy: A Less Invasive Alternative for the Treatment of Ovarian Endometriomas Prior to IVF

Sclerotherapy: A Less Invasive Alternative for the Treatment of Ovarian Endometriomas Prior to IVF

Wound dehiscence at a 7-mm port site closed with tissue adhesive

Objective To describe the herniation of omentum through a 7-mm suprapubic port site, which had been closed with tissue adhesive, following laparoscopic sterilization, requiring repair under general anaesthetic. Setting Minimal access gynaecological surgery unit in a district general hospital. Subject A 26-year-old multiparous woman who presented with abdominal pain and an omental herniation through her suprapubic port site. Intervention The patient required repeat laparoscopy and digital reduction of the hernia with formal repair of the rectus sheath defect. Conclusion This case of herniation through a midline 7-mm port site may have implications for the closure of wounds at laparoscopy. Most gynaecologists do not formally close the rectus sheath at laparoscopic sterilization; however, with the possibility of visceral herniation and vascular compromise, this practice may change in the future. It is not clear whether the tissue adhesive had a role in this complication.

Postlaparoscopic cholecystectomy pelvic gallstones associated with chronic pain

A 23-year-old gravida 1, para 1 woman experienced chronic pelvic pain and cul-de-sac nodularity starting 1 year after laparoscopic cholecystectomy. Repeat laparoscopy revealed numerous clusters of gallstones that were removed, resulting in resolution of her symptoms. Gallstones should be included in the differential diagnosis of the symptomatic patient with a history of cholecystectomy, and surgical records should be carefully reviewed for spillage of stones. It is feasible to remove gallstones laparoscopically.

Role of relaparoscopy in the management of minor bile leakage after laparoscopic cholecystectomy.

Bile leakage in the absence of major ductal injury may occur from the liver bed or from the cystic duct remnant after cholecystectomy. The early limitations of minimally invasive surgery led to reliance on endoscopic methods to manage this complication. However, repeat laparoscopy permits drainage of the bile collection and direct control of the site of leakage in selected situations. Details of 15 patients with bile leakage after laparoscopic cholecystectomy were recorded prospectively and are reviewed. Postoperative bile leakage occurred after 15 (0.8 per cent) of 1779 laparoscopic cholecystectomies. Two patients with bile in drainage fluid had spontaneous resolution. Ten patients with a subvesical duct leak had repeat laparoscopy. The leak was successfully controlled by suturing in eight patients, and by a laparoscopically placed drain in two. One patient required a subsequent laparotomy for a loculated pelvic collection. Three patients had cystic duct stump leakage. This was managed successfully by laparoscopy in one case but required endoscopic management in two. Laparoscopy is useful in the management of minor bile leaks after laparoscopic cholecystectomy. Selection of appropriate patients relies on a characteristic clinical presentation after an otherwise uncomplicated cholecystectomy.

Laparoscopic treatment of lymphocele after kidney transplantation.

Laparoscopic treatment of pelvic lymphocele secondary to kidney transplant has gained popularity in the last few years, although lesions of the urinary tract (ureter, renal pelvis, and bladder) have been reported frequently. To evaluate the result of this treatment and the associated risk of urinary tract lesions, we reviewed our experience and reports in the medical literature on open and laparoscopic surgery. From 1991 to 1999, we laparoscopically treated 12 patients (7 men and 5 women; median age, 43 years; range, 17-59 years) with symptomatic pelvic lymphocele causing a deterioration of renal function because of compression on the ureter in 10 of the 12 patients and lymphocele compression of the iliac vein in the other 2 patients. In nine patients, the lymphocele wall was opened and sutured to the peritoneum to keep the window open. In two patients, an omentoplasty was performed, and in the remaining patient, both techniques were used. All patients were followed up clinically with ultrasound and biochemistry for a median period of 33 months (range, 1-96 months). Using Medline, we reviewed the medical literature from 1980 to 1998 and collected 252 cases in which operations had been performed to drain an internal lymphocele secondary to kidney transplantation. Laparoscopic treatment was successful in 11 of the 12 patients. One patient was converted to open surgery because of a lesion in the transplanted ureter. One patient needed repeat laparoscopy 24 hours after the operation because of bleeding from the peritoneal window. The median duration of the operation was 120 min (range, 70-200 min), and the median postoperative hospital stay was 5 days (range, 2-12 days). None of the patients needed to discontinue oral cyclosporine assumption. The serum creatinine level dropped significantly after surgery (p < 0. 05). No symptomatic recurrences were observed. Of the 252 patients found in the medical literature, in 129 the procedure was performed with open surgery and in 123 laparoscopically (our 12 patients included). The prevalence of iatrogenic lesions to the urinary tract increased threefold with the use of laparoscopic surgery (from 1.6% in open surgery to 7% in laparoscopy). The recurrence rate of symptomatic lymphocele, however, decreased from 15% to 4%. Laparoscopic drainage of posttransplantation lymphocele is a relatively simple method for treating this complication, although it bears the burden of an increased incidence of urinary tract lesions, as confirmed by a review of the literature. The major advantage of the laparoscopic approach is the absence of postoperative ileus with the opportunity to continue the enteral immunosuppressive regimen and a lower recurrence rate. These data suggest that laparoscopic lymphocele treatment might be considered the therapy of choice, provided the iatrogenic lesions of the urinary tract diminish as more experience with this technique is gained.

A laparoscopic technique for obtaining ovarian cortical biopsy specimens for fertility conservation in patients with cancer

Objective: To evaluate the efficacy of a newly designed round biopter as a practical and safe method for collecting ovarian tissue for cryopreservation in young women with cancer before chemotherapy. Design: Prospective study of young women volunteering for research (Leeds, United Kingdom) and patients with cancer (Jerusalem, Israel and Leeds, United Kingdom) undergoing laparoscopic ovarian cortical tissue biopsy and cryopreservation before administration of high-dose radiochemotherapy. Setting: Two university-based tertiary referral centers of oncology and gynecology (Hadassah Medical Center, Israel; Leeds General Infirmary, United Kingdom). Patient(s): Twenty female volunteers undergoing routine laparoscopic gynecologic procedures (age, 25–34 years) and 20 young women (age, 11–30 years) with advanced cancer requiring potentially sterilizing radiochemotherapy. Intervention(s): Cortical ovarian tissue biopsies performed under laparoscopy with use of the round biopter. Result(s): The laparoscopic sampling procedure was uncomplicated in all cases. In treated patients, five to six samples were obtained (5 mm in diameter; 2–3 mm in depth) using the round biopter, and radiochemotherapy was administered without delay. In volunteers, no adhesions were noted at repeat laparoscopy (9 patients). All biopsy specimens were cryopreserved, and histologic examination confirmed the presence of many primordial follicles. Conclusion(s): Laparoscopic ovarian biopsy performed with the round biopter is a safe and efficient method for collecting ovarian tissue for cryopreservation in patients with cancer.

Conservative treatment of interstitial pregnancy

ObjectiveTo report a case of interstitial pregnancy diagnosed and treated laparoscopically by cornual resection, and to review the literature in order to provide a perspective on alternative treatment options for this condition.Case reportA 42‐year‐old woman with persistent pelvic pain, elevated levels of beta‐human chorionic gonadotrophin (β‐hCG) and a negative ultrasound scan had an initial negative diagnostic laparoscopy. Symptoms continued and repeat ultrasound suggested an asymmetric fundal pregnancy. Repeat laparoscopy revealed an interstitial pregnancy and laparoscopic cornual resection was undertaken. Recovery was uneventful and she was discharged 2 days postoperatively.Current perspectiveWhen interstitial pregnancy is detected early, treatment options include expectant management, systemic methotrexate, or local injection of methotrexate, potassium chloride or prostaglandin into the gestational sac. Surgical intervention by hysteroscopic removal or laparoscopic cornual excision/cornuostomy can be employed in the case of failed medical treatment or advanced pregnancy.ConclusionThe early diagnosis of interstitial pregnancy should enable a conservative approach, whether medical or surgical, to be undertaken when treating this rare and potentially fatal condition.