Successful treatment of a heterotopic tubal pregnancy by gasless laparoscopic surgery

Abstract

Heterotopic pregnancy is a rare event and management is by either laparotomy or laparoscopic surgery to remove the extrauterine pregnancy. As there has been no report detailing the use of gasless laparoscopy for management of heterotopic pregnancy, the authors herein report a case of heterotopic pregnancy that was successfully managed by gasless laparoscopic surgery. The subsequent antenatal course was unremarkable. The intrauterine pregnancy carried to term with uneventful maternal and fetal outcomes. Thus, gasless laparoscopy can be used as an alternative method for the management of heterotopic pregnancy.

Embarazo heterotópico: diagnóstico ecográfico temprano, manejo con laparoscopia. Reporte de un caso y revisión de la literatura

“…16,17 La tasa de detección ultrasonográfica de embarazo heterotópico en mujeres asintomáticas es del 15,8% y puede variar desde 41 hasta 84% en mujeres con dolor pélvico. 9,19,20 El pronóstico del embarazo intrauterino depende de la precocidad del diagnóstico clínico y ecográfico. 5,13 El objet ivo pr incipal en el manejo de est a patolog ía es ter m i na r el emba ra z o extrauterino sin afectar la gestación intrauterina v iable.…”

“…5,13 El objet ivo pr incipal en el manejo de est a patolog ía es ter m i na r el emba ra z o extrauterino sin afectar la gestación intrauterina v iable. 6,7,9,18,20,21 El ma nejo del emba ra zo heterotópico cuenta con varias opciones, incluyendo conducta expectante, inyección guiada por ultrasonido de cloruro de potasio o metotrexate, salpingostomía o salpingectomía abierta o por laparoscopia. 12,13,22 Acerca del manejo con inyección de sustancias hipertónicas o metotrexate en el embrión extrauterino, la seguridad para el embarazo intrauterino no está clara.…”

Gasless Laparoscopy versus Conventional Laparoscopy in Uterine Myomectomy: A Single-Centre Randomized Trial

“…20 A recent report found the recurrence rate of gasless laparoscopy myomectomy was 11.7% after 1 year, 36.1% after 3 years, 52.9% after 5 years and 84.4% after 8 years. 16 Fauconnier et al 21 reported a higher recurrence rate with laparoscopic surgery compared with laparotomy. The relatively high recurrence rate of traditional laparoscopic surgery is primarily a consequence of the omission of small uterine myomas due to inability to palpate the uterus.…”

“…Gasless laparoscopic surgery uses an abdominal-wall lift system to provide surgical space and a clear intra-abdominal view. 16 Because there is no need for artificial pneumoperitoneum, concerns regarding loss of insufflation and the visibility of surgical field are negated. Gasless laparoscopy allows the use of more reliable instruments and techniques, compared with conventional laparoscopy 6,7 and has, therefore, gained popularity among gynaecologists.…”

Gasless laparoscopic surgery during pregnancy: evaluation of its role and usefulness

“…There are reports of the use of CO 2 laparoscopy in the management of heterotopic pregnancy [22,23]. More recently, the first case of heterotopic tubal pregnancy treated using GLS has been reported [24]. The woman was successfully managed under general anesthesia at the seventh week of gestation using GLS salpingectomy of the tubal pregnancy.…”