Laparoscopic Laparoscopic management of Ectopic management of Ectopic

PregnancyPregnancy

Background & IndicationsBackground & Indications

• Although the salpingectomy is definitive surgical management of a tubal ectopic pregnancy, it hinders future fertility by removing the oviduct.

• Thus salpingotomy were sought• In this procedure, an incision on the antimesentric aspect

of the tube allows extraction of the gestational tissue with preservation of the tube.

• Experience have demonstrated that, haemostasis without closure of the tubal incision provide similar tubal patency to primary closure of the tube.

• Healing by secondary intention.

• Laparoscopy is becoming the standared management of unruptured ectopic pregnancy.

• Advantages over minilaparotomy.

Conservative therapy of ectopic Conservative therapy of ectopic pregnancypregnancy

• Pharmacological therapy using methotrexate was introduced by TANAKA 1982.

• proven to be successful in 90% of selected cases.• The American College of Obstetrician and

Gynaecologists recommend Methotrexate for patients who desire future fertility and have an ectopic mass less than 3 cm in diameter, with hCG level less than 15,000mIU/mL and no evidence of fetal heart tone on ultrasonography.

• Follow up is by monitorin hCG.• Tubal patency is 80% in both surgical and

pharmacological therapy. • This leads to an intrauterine pregnancy rate of 75% after

salpingotomy, compared to 44% after salpingectomy.

ProcedureProcedure

• Even for a patient who is thought to be a candidate for conservative therapy, access to the peritoneal cavity is essential to determine the most appropriate procedure.

• Linear salpingotomy if for ectopic in ampulla with unruptured tubal serosa.

• Incision is made on antimesentric side using monopolar electrocautery, laser or harmonic scalple.

• The products of conception are teased from the tubal lumen using, suction, forsceps of hydrodissection.

• Haemorrhage is controlled using bipolar forceps.• Persistant blood oozing render some surgeons

inject diluted vasopressin in the mesosalpinx.• Tubal incision is left to heal by secondary

intension.• According to the wish of patient either

salpingotomy or salpingectomy is performed.

• Conception tissue either removed from 10 mm port, or from a colpotomy .

• Colpotomy is fascilitated by streching the posterior vaginal wall.

• Colpotomy later is closed using absorbable sutures