Cornual resection for interstitial pregnancy by laparoendoscopic single-site surgery

Lazard, A.; Poizac, S.; Courbière, Blandine; Cravello, L.; Gamerre, M.; Agostini, Aubert

doi:10.1016/j.fertnstert.2011.03.056

Cited by 16 publications

(4 citation statements)

References 17 publications

(28 reference statements)

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“…This has been considered for many years a safe and effective treatment for ectopic pregnancy, with a higher likelihood of success by lowering quantitative β‐hCG, which represents the main prognostic factor . Failure and rupture can occur in patients treated with the conservative approach, so they need adequate counseling and serial biochemical and ultrasonographic follow‐up …”

Section: Discussionmentioning

confidence: 99%

“…10 Failure and rupture can occur in patients treated with the conservative approach, so they need adequate counseling and serial biochemical and ultrasonographic follow-up. 11 The surgical approach with cornual resection, cornuotomy or, in extreme cases, hysterectomy is necessary in case of hemodynamic impairment or when MTX administration is not allowed. 6 Some authors 12 consider cornual resection a low-hemorrhagic risk procedure, whereas others consider it a high-hemorrhagic risk procedure; this risk can be reduced through intramyometrial injection of vasopressin or by bilateral surgical ligation of both uterine vessels using extracorporeal knots, as suggested by Uccella et al 13 An alternative treatment option was described by Cerviño et al who combined systemic MTX and transcervical transisthmic evacuation under sonographic and laparoscopic guidance for the conservative management of an interstitial dichorionic twin pregnancy.…”

Section: Discussionmentioning

confidence: 99%

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Conservative treatment for interstitial monochorionic twin pregnancy: Case report and review of the published work

Berretta

Merisio

Dall’Asta

et al. 2013

J of Obstet and Gynaecol

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Interstitial pregnancy is considered one of the most hazardous types of ectopic pregnancies, with a mortality rate of 2-2.5%. We describe a case of a viable monochorionic twin pregnancy in a 35-year-old woman successfully treated with systemic methotrexate associated with bilateral uterine arteries' embolization. β-hCG was undetectable 67 days after the first administration of methotrexate and the ultrasonography performed on day 67 showed the remnant of the gestational sac in the right uterine horn, a thin endometrium and a normal myometrial vascularization. Conservative treatment allowed us to avoid surgical treatment and to preserve the patient's fertility.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Conservative treatment for interstitial monochorionic twin pregnancy: Case report and review of the published work

Berretta

Merisio

Dall’Asta

et al. 2013

J of Obstet and Gynaecol

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“…In the papers we analyzed, the vast majority of the patients underwent a salpingectomy, although in a few cases, a cornual or an ovarian wedge resection was performed as well. The management of cornual pregnancies via conventional laparoscopy or LESS has been described and, while more complicated than the management of a conventional ectopic pregnancy, is feasible [20, 21]. We speculate that the salpingectomy is such an easy procedure that a change in surgical approach does not translate into a longer OR time.…”

Section: Discussionmentioning

confidence: 97%

Conventional versus Single Port Laparoscopy for the Surgical Treatment of Ectopic Pregnancy: A Meta-Analysis

Gasparri¹,

Mueller²,

Taghavi³

et al. 2018

Gynecol Obstet Invest

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Background/Aims: A new minimally invasive laparoscopic approach for ectopic pregnancy, the laparo-endoscopic single site surgery (LESS), has recently been introduced. The aim of this study is to compare the surgical outcome of this approach with conventional laparoscopy for ectopic pregnancy. Method: A review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement was performed. Electronic databases PubMed, MEDLINE, and Scopus were searched in December 2017 by searching the terms “single port laparoscopy” or “laparoendoscopic single site-surgery” or “single site laparoscopy” or “single-incision laparoscopic surgery” and “ectopic pregnancy.” Studies comparing the 2 techniques and reporting surgical outcome were selected. Endpoints included comparison of length of operative time (OT), hemoglobin drop, length of hospitalization, number of patients requiring packed red blood cells (PRBC) transfusion, intra- and post-operative complication rates between patients undergoing conventional laparoscopy and those undergoing LESS. Results: A total of 56 studies were retrieved of which 5 studies including 460 patients met selection criteria. No differences were found between conventional laparoscopy and LESS with regards to length of OT time (even after stratification for presence of hemoperitoneum and/or adhesions), length of hospitalization, mean hemoglobin drop, number of patients requiring transfusions of PRBC, and intra- and post-operative complications. Conclusion: The management of ectopic pregnancies with LESS does not seem to be superior to conventional laparoscopy.

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“…In all cases of interstitial rupture, interstitial salpingotomy, and cornual wedge resection, it is necessary to close the uterine horn with absorbable sutures. Alternative surgical methods include the use of laparoendoscopic single-site surgery ( 23 ), the use of a temporary tourniquet suture in order to reduce bleeding ( 24 ), the laparoscopic salpingocentesis with methotrexate in combination with oral mifepristone ( 25 ), and the laparoscopic and ultrasound-guided transcervical evacuation ( 26 ). In order to avoid tubal rupture, the possibility of leaving the placenta in situ during transcervical evacuation of the gestational products under abdominal US guidance has also been reported, under the condition that an IM dose of methotrexate should be administered immediately after the operation ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Management of Interstitial Pregnancy and Fertility Outcomes after Ipsilateral Salpingectomy â€“ Three Case Reports

et al. 2014

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Background: Interstitial pregnancy after ipsilateral salpingectomy is a rare event with potentially serious consequences. Optimal management strategy remains uncertain and debated. In addition, fertility sparing is determinant of the treatment choice.Cases: Here, we report three cases of interstitial pregnancy occurring after homolateral salpingectomy. We expose the therapeutic option held in all three situations, which associated laparoscopic procedure followed by intramuscular methotrexate injection with successful outcome for all patients. We also report the fertility outcome for the first patient, discussing the timing and mode of delivery. Cesarean section at term was performed for this patient.Conclusion: In these three situations, we obtained a successful result using a minimally invasive surgical approach combined with systemic methotrexate injection. Cesarean section at term for subsequent intrauterine pregnancy seems to be the safest delivery strategy, although no clear data exist in literature.

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Cornual resection for interstitial pregnancy by laparoendoscopic single-site surgery

Cited by 16 publications

References 17 publications

Conservative treatment for interstitial monochorionic twin pregnancy: Case report and review of the published work

Conservative treatment for interstitial monochorionic twin pregnancy: Case report and review of the published work

Conventional versus Single Port Laparoscopy for the Surgical Treatment of Ectopic Pregnancy: A Meta-Analysis

Laparoscopic Management of Interstitial Pregnancy and Fertility Outcomes after Ipsilateral Salpingectomy â€“ Three Case Reports

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