Minimally invasive surgical management of a cornual ectopic pregnancy, with and without a concurrent intrauterine pregnancy

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Authors:

Stephanie I. Delgado, M.D., Tamisa Koythong, M.D., Xiaoming Guan, M.D. 

Abstract:

Objective

To describe techniques for resection of a cornual heterotopic pregnancy.


Design

This video demonstrates a surgical technique for excision of a cornual heterotopic pregnancy with narrative video footage using two case examples.


Setting

The incidence of cornual heterotopic pregnancy is unknown; however, the incidence of heterotopic pregnancy itself has increased through the use of assisted reproductive technologies and the majority of cornual heterotopic pregnancies occur after assisted reproductive technologies use. These cases have been treated traditionally using exploratory laparotomy and cornual wedge resection with good outcomes. With advancements in minimally-invasive surgical techniques, laparoscopic resection of cornual heterotopic pregnancies has been demonstrated to be safe and feasible.


Patient(s)

A patient with an 8-week cornual heterotopic pregnancy and a patient with a 10-week cornual ectopic pregnancy.


Interventions

Laparoscopic resection of the cornual ectopic pregnancy.


Main Outcome Measure(s)

Feasibility of a “purse-string” technique for the resection of a heterotopic cornual pregnancy.


Result(s)

Robotic-assisted laparoscopic resection of a cornual heterotopic pregnancy can be performed with minimal blood loss with the use of the “purse-string” technique in settings where vasopressin cannot be used for hemostasis. This technique includes the use of a 2-0 V-Loc suture in a circumferential fashion around the ectopic pregnancy, which allows for faster suturing and immediate tension at the myometrium. The same suture is then used to close the defect, which allows for a simpler and efficient closure with minimal entry into the myometrium.


Conclusion(s)

In this video, we demonstrate the successful resection of cornual heterotopic pregnancy using a “purse-string” surgical technique. This technique allows for minimal blood loss in cases where additional techniques for hemostasis cannot be used, such as injection of vasopressin and uterine artery ligation.

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.