https://www.laparoscopyhospital.com/SERV01.HTM<br /><br />Ectopic pregnancy, a condition where the fertilized egg implants outside the uterine cavity, is a potentially life-threatening condition requiring prompt diagnosis and management. The fallopian tube is the most common site for ectopic pregnancies, accounting for approximately 95% of cases. The advent of laparoscopy has revolutionized the management of ectopic pregnancy, offering a minimally invasive approach with reduced morbidity, shorter hospital stays, and quicker recovery times compared to traditional open surgery.<br /><br />Pathophysiology<br /><br />Ectopic pregnancy occurs when the fertilized ovum fails to travel down the fallopian tube into the uterus. Predisposing factors include tubal damage from previous surgeries, infections (like pelvic inflammatory disease), and conditions like endometriosis. The classical presentation includes abdominal pain, amenorrhea, and vaginal bleeding, although many cases are diagnosed incidentally during early ultrasound scans.<br /><br />Indications for Laparoscopic Management<br /><br />Laparoscopy is considered the gold standard for the surgical management of ectopic pregnancy. The primary indications include:<br /><br />Hemodynamically stable patients<br />Unruptured ectopic pregnancy<br />Ectopic mass smaller than 5 cm<br />Serum beta-hCG levels below 15,000 IU/L<br />Desire for future fertility preservation<br />Preoperative Preparation<br /><br />Preoperative preparation involves stabilization of the patient, ensuring hemodynamic stability, and obtaining informed consent. Transvaginal ultrasonography is used to confirm the diagnosis and assess the location and size of the ectopic pregnancy. Baseline serum beta-hCG levels are also essential for postoperative monitoring.<br /><br />Surgical Technique<br /><br />Port Placement:<br /><br />A supraumbilical port is placed for the laparoscope to provide an optimal view of the pelvic organs, particularly in cases where a tubo-ovarian mass is suspected. Additional accessory ports are placed under direct visualization, typically in the lower abdomen, to facilitate manipulation and retraction.<br />Diagnosis:<br /><br />The pelvis is inspected to confirm the site of the ectopic pregnancy. The fallopian tubes, ovaries, and uterus are carefully examined for signs of rupture, bleeding, or other pathology.<br />Salpingostomy:<br /><br />In cases where the fallopian tube is not ruptured and future fertility is a concern, a linear incision is made on the antimesenteric border of the fallopian tube, directly over the site of implantation. The ectopic tissue is removed using atraumatic graspers, and the tube is left to heal by secondary intention.
