Laparoscopic treatment of ectopic pregnancy; with salpingectomy and/or oophorectomy
CPT4 code
Name of the Procedure:
Laparoscopic Treatment of Ectopic Pregnancy; with Salpingectomy and/or Oophorectomy
Commonly referred to as laparoscopy for ectopic pregnancy
Summary
This minimally invasive surgery addresses an ectopic pregnancy by removing the affected fallopian tube (salpingectomy) and possibly the ovary (oophorectomy) using a laparoscope, a thin instrument with a camera.
Purpose
This procedure resolves ectopic pregnancy (when a fertilized egg implants outside the uterus, often in a fallopian tube), which can cause severe complications if untreated. The goal is to remove the pregnancy and damaged tissues to prevent rupture and severe internal bleeding.
Indications
- Suspected or confirmed ectopic pregnancy
- Severe pelvic pain or bleeding suggestive of rupture
- Non-viable pregnancy diagnosed through ultrasound
- Failed medical management with methotrexate
Preparation
- Fasting after midnight before the surgery
- Review of current medications; certain medications may need to be stopped
- Blood tests and an ultrasound to confirm the ectopic pregnancy
- Possibly a human chorionic gonadotropin (hCG) level check
Procedure Description
- The patient is placed under general anesthesia.
- A small incision is made near the navel, and the abdomen is inflated with carbon dioxide.
- A laparoscope is inserted to visualize the pelvic organs.
- Additional small incisions are made for surgical instruments.
- The ectopic pregnancy is located and removed, along with the fallopian tube (salpingectomy) and/or ovary (oophorectomy) if damaged.
- The instruments are removed, and the incisions are closed with sutures or adhesive.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
Usually performed in a hospital's operating room or a specialized surgical center.
Personnel
Involves a team including a gynecologic surgeon, anesthesiologist, surgical nurses, and scrub technicians.
Risks and Complications
- Common: Pain, bleeding, infection
- Rare: Damage to nearby organs, blood clots, reactions to anesthesia
- Possible complications: Persistent ectopic tissue requiring further treatment, adhesion formation
Benefits
- Immediate resolution of the ectopic pregnancy
- Minimally invasive with faster recovery and less scarring
- Reduced risk of life-threatening complications like tubal rupture
Recovery
- Initial recovery in a hospital for a few hours
- Instructions on pain management, activity restrictions, and wound care
- Follow-up appointment within a week
- Generally back to normal activities in about 1 to 2 weeks
Alternatives
- Medical management: Methotrexate injection to dissolve the ectopic pregnancy (suitable for earlier, unruptured cases).
Open surgery (laparotomy): Required for more extensive damage or complications.
Each alternative varies in recovery time, invasiveness, and applicability based on specific patient circumstances.
Patient Experience
- Typically, patients experience abdominal discomfort and mild pain post-surgery, which is managed with prescribed pain medication.
- Some degree of bloating or shoulder pain due to the laparoscopic procedure is common but temporary.
- Emotional support might be needed as the patient deals with the loss of pregnancy.