Name of the Procedure:

Laparoscopic Treatment of Ectopic Pregnancy (without Salpingectomy and/or Oophorectomy)

Summary

Laparoscopic treatment of ectopic pregnancy is a minimally invasive surgical procedure that addresses an ectopic pregnancy, where the embryo implants outside the uterus, typically in the fallopian tubes. This procedure aims to remove the ectopic pregnancy without removing the fallopian tubes (salpingectomy) or ovaries (oophorectomy).

Purpose

The procedure addresses ectopic pregnancies, which can be life-threatening if left untreated due to the risk of fallopian tube rupture and internal bleeding. The goal is to safely remove the ectopic tissue while preserving the reproductive organs for future fertility.

Indications

• Suspected or confirmed ectopic pregnancy.
• Abnormal vaginal bleeding or pain in early pregnancy.
• Rising or plateauing hCG levels without evidence of intrauterine pregnancy on ultrasound.
• Tubal mass detected on transvaginal ultrasound.

Preparation

• Fasting for 8 hours before surgery.
• Adjustments in medications, particularly blood thinners.
• Blood tests, including complete blood count (CBC), hCG levels, and blood type.
• Pelvic ultrasound to locate the ectopic pregnancy.

Procedure Description

1. The patient is placed under general anesthesia.
2. Small incisions are made in the abdomen to insert a laparoscope (a thin, lighted tube with a camera) and surgical instruments.
3. The surgeon carefully locates and removes the ectopic tissue while preserving the fallopian tube.
4. Any bleeding is controlled, and the area is inspected for additional ectopic tissue or complications.
5. The instruments are removed, and the incisions are closed with sutures or surgical glue.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Performed in a hospital or surgical center with access to an operating room.

Personnel

• Surgeon (typically a gynecologist with laparoscopic training)
• Anesthesiologist
• Surgical nurse
• Scrub technician

Risks and Complications

• Bleeding or infection.
• Damage to surrounding organs (bowel, bladder).
• Adhesions (scar tissue) formation.
• Residual ectopic tissue requiring further treatment.
• Risks associated with anesthesia.

Benefits

• Effective removal of ectopic pregnancy.
• Preservation of fallopian tubes and fertility.
• Minimal scarring and quicker recovery compared to open surgery.
• Reduced pain and shorter hospital stay.

Recovery

• Initial rest and activity limitations for a few days.
• Pain management with prescribed medications.
• Avoiding strenuous activities and heavy lifting for 2 to 4 weeks.
• Follow-up appointment to monitor recovery and hCG levels to ensure all ectopic tissue has been removed.

Alternatives

• Medical management with methotrexate, a medication that stops cell growth and dissolves the pregnancy.
  • Pros: Non-surgical.
  • Cons: Multiple doses and follow-ups, side effects (e.g., nausea), less immediate resolution.
• Laparotomy (open abdominal surgery).
  • Pros: Effective for complicated cases.
  • Cons: Larger incision, longer recovery time, more pain.

Patient Experience

• During: Patient will be under general anesthesia and won’t feel any pain.
• After: Some post-operative pain and discomfort at the incision sites, which can be managed with painkillers. Patients might also experience mild shoulder pain due to the gas used in the procedure. Most patients can resume normal activities within a week, with complete recovery in 2 to 4 weeks.