Fertility Preserving Laparoscopic Approach for Scar Ectopic Pregnancy Excision

Abstract

Study Objective

Surgical management of cesarean section scar ectopic pregnancy with temporary ligation of bilateral uterine artery at origin with shoelace knot technique.

Design

A stepwise video demonstration of procedure.

Setting

Surgery was done using 2D high-definition laparoscopy by qualified and experienced team.

Patients or Participants

A 30-year-old patient presented with 2-months amenorrhoea with vaginal bleeding and pain in lower abdomen. She had undergone two full term cesarean section. Patient was willing to preserve her fertility. Consent was obtained from patient for surgical management.

Interventions

Laparoscopic management of cesarean scar ectopic pregnancy with temporary ligation of bilateral uterine arteries at origin.

Measurements and Main Results

On USG, live cesarean scar ectopic pregnancy of 8 weeks gestation type IIa was diagnosed. Her B-HCG level was 26,400 IU/L. Surgical treatment was planned for her. In this video, we stepwise described our technique: 1) Adhesiolysis of omentum from anterior abdominal wall. 2) Retroperitoneum was opened. Temporary ligation of bilateral uterine arteries at origin was done with shoelace knot technique. 3) Uterus was densely adherent to anterior abdominal wall, dissected down. 4) Bladder dissection was done to expose scar. 5) Intramyometrial injection of vassopressin was given. 6) Complete evacuation of products of conception was done 7) Uterine scar repair was done with 1-0 vicryl. 8) Bilateral uterine arteries ligature was released. The surgery was uneventful with minimal blood loss.

Conclusion

Laparoscopic excision of cesarean scar ectopic pregnancy is a safe, effective, easily adaptable minimal invasive procedure for maintaining haemostasis, simultaneous repair of scar that lead to successful revision with minimal impact to subsequent fertility.