Cervical Ectopic Pregnancy: Tips and Tricks for Laparoscopic Management

Study Objective

To demonstrate a methodology for laparoscopic en-bloc resection of a cervical ectopic pregnancy using eight reproducible steps, focusing on minimizing potential blood loss and preserving fertility.

Design

Surgical video outlining the steps of laparoscopic en-bloc resection of a cervical ectopic pregnancy using examples from a single case.

Setting

The highlighted surgery was performed at a tertiary referral center by a single surgeon specialized in minimally invasive gynecological surgery and robotics.

Patients or Participants

A 27-year-old patient, gravida two, para one, presented with vaginal bleeding and a positive home pregnancy test. She had a history of one prior cesarean section via a low transverse uterine incision. On transvaginal ultrasound, she was found to have an abnormally implanted pregnancy within the proximal cervical canal. The pregnancy measured approximately 6 weeks gestational age, and cardiac activity was present.

Interventions

After discussion of various management options, the patient was consented for robotic-assisted laparoscopic en-bloc resection of the cervical ectopic pregnancy with a plan for possible repair of isthmocele. The surgical approach highlights eight reproducible steps, including: 1) utilization of pelvic retroperitoneal spaces to delineate the borders of the ectopic pregnancy; 2) identification of ureters; 3) skeletonization of uterine arteries; 4) ensuring hemostasis with the use of laparoscopic bulldog clamps and dilute vasopressin; 5) identification of the cervicovaginal junction; 6) removal of the ectopic pregnancy en-bloc; 7) identification of the cervical canal; 8) reapproximation of the cervix in multiple layers.

Measurements and Main Results

Laparoscopic en-bloc resection of a cervical ectopic pregnancy was completed successfully without intraoperative complications and minimal blood loss.

Conclusion

Cervical ectopic pregnancy can be treated surgically through a systematic minimally invasive approach. Timely intervention and the surgical techniques as demonstrated are essential for ensuring hemostasis, optimizing outcomes, and preserving fertility in these rare cases.