59121 Surgical treatment of ectopic pregnancy; tubal or ovarian, without salpingectomy and/or oophorectomy

Name of the Procedure:

Surgical treatment of ectopic pregnancy; tubal or ovarian, without salpingectomy and/or oophorectomy

Summary

This is a surgical procedure to treat an ectopic pregnancy, where the fertilized egg implants outside the uterus, typically in the fallopian tube or ovary. The procedure involves removing the ectopic pregnancy without removing the fallopian tube (salpingectomy) or ovary (oophorectomy).

Purpose

The primary goal is to treat an ectopic pregnancy, which can be life-threatening if not managed promptly. The expected outcome is to remove the ectopic tissue while preserving the fallopian tube and ovary to maintain the patient's fertility.

Indications

• Suspected or confirmed ectopic pregnancy
• Abdominal pain and vaginal bleeding in pregnancy
• Elevated hCG levels with no intrauterine pregnancy visible on ultrasound
• Hemodynamic instability or rupture of an ectopic pregnancy

Preparation

• Fasting for at least 8 hours before the procedure
• Stopping certain medications, as directed by the clinician
• Pre-operative blood tests, ultrasound, and possibly an MRI or CT scan
• Arranging for someone to drive the patient home after the procedure

Procedure Description

1. The patient receives general anesthesia.
2. A small incision is made in the abdomen, usually near the navel.
3. A laparoscope (a small tube with a camera) is inserted through the incision.
4. Additional small incisions may be made for surgical instruments.
5. The surgeon carefully removes the ectopic pregnancy tissue.
6. Hemostasis is achieved to control any bleeding.
7. The incisions are closed with sutures or staples.
8. The patient is moved to recovery to monitor their immediate postoperative condition.

Duration

Typically, the procedure lasts between 30 minutes to 1 hour.

Setting

The procedure is performed in a hospital or surgical center.

Personnel

• Surgeon (gynecologist or specialist in reproductive surgery)
• Anesthesiologist
• Surgical nurses and technicians
• Recovery room nurses

Risks and Complications

• Infection
• Bleeding
• Damage to surrounding organs (fallopian tubes, ovaries, intestines, bladder)
• Anesthesia risks
• Scar tissue formation or adhesions
• Risk of another ectopic pregnancy

Benefits

• Resolves the ectopic pregnancy, preventing potential life-threatening complications
• Preservation of fallopian tubes and/or ovaries to maintain fertility
• Immediate improvement of symptoms

Recovery

• Monitoring in the recovery room for a few hours post-surgery
• Pain management with prescribed medications
• Instructions to avoid strenuous activities and heavy lifting for a few weeks
• Follow-up appointments to monitor recovery and hCG levels
• Possible restrictions on driving and sexual activity for a few weeks

Alternatives

• Medical management with methotrexate (less invasive but may not be suitable for all cases)
• Expectant management (watchful waiting in cases of very early ectopic pregnancy, with the risk of rupture)
• Salpingectomy or oophorectomy if the tube or ovary is too damaged to be preserved

Patient Experience

• Patients might feel groggy and sore post-procedure.
• Mild to moderate pain at the incision sites, managed with medications.
• Some bloating or shoulder pain due to the gas used in laparoscopy.
• Emotional impact and psychological support may be needed due to the pregnancy loss.
• Gradual return to normal activities within 1-2 weeks.