Zeynep BAYRAMOĞLU, Erhan OKUYAN, Çağlar ALTUNDAL

Safe, easily applicable mini-laparotomic surgical steps in cornual ectopic pregnancy: Case report and demonstration of surgical technique

In the management of rare cornual ectopic pregnancy, there is no consensus on surgical treatment modalities in obstetric practice.In this article, we aimed to describe the safe and easily applicable minilaparotomic surgical steps with black pencil drawings. A5-centimeter-size of Pfannenstiel incision was made to enter the abdomen with sterile covering under operating room conditions.After evaluating the topographic anatomy of the uterus and adnexa, a window was opened just below the ligamentum ovarii propriumand skeletonization of the cornual ectopic pregnancy was achieved. Then, ligamentum ovarii proprium was ligated and cut by using1.0 vicryl and U sutures were placed in 3 planes after skeletalization of cornual ectopic pregnancy mass. After cornuotomy wasperformed and the pregnancy material was removed the uterine myometrium layer and serosa were closed separately with baseballstitches. Total operation time was 20 minutes, perioperative blood loss was recorded as 50 ccs/dl and the patient was discharged at24th hour without any complications. With this surgical technique applied with minilaparotomic incision, fertility-preserving surgerycan be performed in a short time without causing excessive blood loss or hysterectomy. Studies involving many cases are neededto prove perioperative and postoperative results of this surgical technique.

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1. Balsak D, Inal M, Yildirim Y, et al. Successful Treatment of Unruptured Cornual Pregnancy Usıng Intravenous Methotrexate: A Case Report. Turgut Özal Tıp Merkezi Dergisi 2007;14:1.
2. Yoong W, Neophytou C, de Silva L, et al. Novel laparoscopic cornual resection of interstitial pregnancy using the Endo GIA™ Universal Stapler (Medtronic): A series of 12 cases. Aust N Z J Obstet Gynaecol 2019.
3. Egger E. Recurrent Interstitial Pregnancy: a Review of the Literature. Geburtshilfe Frauenheilkd 2017 ;77:335-9.
4. Jurkovic D, Mavrelos D. Catch me if you scan: ultrasound diagnosis of ectopic pregnancy. Ultrasound Obstet Gynecol 2007;30:1-7.
5. Moawad NS, Mahajan ST, Moniz MH, et al. Current diagnosis and treatment of interstitial pregnancy. Am J Obstet Gynecol 2010;202:15-29.
6. Morgana M, Aziza M, Mikhaila M, et al. Ultrasoundguided treatment of cornual ectopic pregnancy. Ultrasound Obstet Gynecol 2003;25:272-5.
7. Grindler NM, Ng J, Tocce K, et al. Considerations for management of interstitial ectopic pregnancies: Two case reports. J Med Case Rep 2016;10:106.
8. Ng S, Hamontri S, Chua I, et al. Laparoscopic management of 53 cases of cornual ectopic pregnancy. Fertil Steril 2009;92:448-52.
9. Watanabe T, Watanabe Z, Watanabe T, et al. Laparoscopic cornuotomy for interstitial pregnancy and postoperative course. J Obstet Gynaecol Res 2014;40:1983-8.
10. Gezer A, Mutlu H. Laparoscopic management of cornual pregnancy without sutures. Arch Gynecol Obstet 2004;270:194-6.
11. Pasic RP, Hammons G, Gardner JS, et al. Laparoscopic treatment of cornual heterotopic pregnancy. J Am Assoc Gynecol Laparosc 2002;9:372-5.
12. Dagar M, Srivastava M, Ganguli I, Bhardwaj P, Sharma N, Chawla D. Interstitial and Cornual Ectopic Pregnancy: Conservative Surgical and Medical Management. J Obstet Gynaecol India. 2018 Dec;68(6):471-476. DOI: 10.1007/s13224-017-1078-0. Epub 2017 Nov 28. PMID: 30416274; PMCID: PMC6207538..
13. Kumar A, Pearl M. Mini-laparotomy versus laparoscopy for gynecologic conditions. J Minim Invasive Gynecol 2014;21:109-14.
14. Kucukozkan T, Ozkaya E, Ucar FO, et al. Hysterectomy for large symptomatic myomas: mini-laparotomy versus midline vertical incision. Arch Gynecol Obstet 2011;284:421-5.
15. Bhave Chittawar P, Franik S, Pouwer AW, et al. Minimally invasive surgical techniques versus open myomectomy for uterine fibroids. Cochrane Database Syst Rev 2014;CD004638.