Laparoscopic Management of Interstitial Ectopic Using Simple and Safe Technique: Case Series and Review of Literature

Abstract

Background and Objective: To determine the safety and sustainability of operative laparoscopy in surgical management of cornual and interstitial ectopic pregnancy using a simple and practical method. Design: Case series of five consecutive cases. Setting: Endoscopy unit in Alexandria University Hospital and Alexandria New Medical Center. Patients: Between July 2013 and May 2015, five women with interstitial and cornual ectopic pregnancies were admitted for laparoscopic surgical treatment. Methods: Full medical and surgical histories were taken. We explained all alternatives for both partners before informed. Patients underwent laparoscopy for management of the corneal ectopic. All surgeries were done by the same surgeon (T.S.) with different assistants. We gave different uterotonics drugs to devascularize the uterus. Two or more devascularization sutures were done on each end of the corneal ectopic. We used monopolar and bipolar electrocoagulation when indicated. We did linear cut of the interstitial ectopic with evacuation of the fetus and placental tissues. Extraction of the conceptus was performed through 10 mm port. Follow-up of the beta-hCG was done weekly till negative results were obtained. Results: The devascularization sutures together with uterotonics make the surgical treatment of interstitial ectopic easy and safe. This simple technique minimizes blood loss and decreases necrosis that follows excessive use of diathermy. This was demonstrated successfully in different types of interstitial ectopic. We did not remove any part of the uterus during surgery. Clinical criteria of the study cases were discussed. Type, size, blood loss and complications, and duration of the surgery were documented. Conclusion: Operative laparoscopy using sutures and uterotonics is safe and sustainable approach in treatment of interstitial ectopic pregnancy.