Endoloop technique for laparoscopic cornuectomy: A safe and effective approach for the treatment of interstitial pregnancy

Faioli, Raffaele; Berretta, Roberto; Dall’Asta, A.; Serio, Maurizio Di; Galli, Letizia; Monica, Michela; Frusca, T.

doi:10.1111/jog.13005

Cited by 8 publications

(8 citation statements)

References 15 publications

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“…9 Extrauterine pregnancies are localized in 95% of cases in the tube and only 2% of them within the interstitial wall of the tube. 10 In our case, interstitial pregnancy diagnosis was pointed out by ultrasoundbased criteria as suggested by Timor-Tritsch et al 11 Methotrexate treatment for interstitial pregnancy has a success rate of 88-100% 8,12 in our case, the patients' young age, willing of future pregnancy and absence of an embryo heartbeat leaded our clinical management into a conservative treatment with methotrexate im administration. In present literature, there are no clear data on the timing of US follow-up at long term after medical treatment.…”

Section: Discussionmentioning

confidence: 58%

Arteriovenous uterine malformation developed from an interstitial pregnancy on residual tubal stump: A critical managment in a fertile woman

Parisi

Garofalo

Alemanno

et al. 2019

J of Obstet and Gynaecol

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Uterine arteriovenous malformations are rare conditions with diverse clinical presentation that range from asymptomatic patients to different degrees of menorrhagia, commonly associated with previous pregnancy or uterine trauma. This case report describes a 36‐year‐old woman who presented with ultrasound diagnosis of interstitial pregnancy on residual right tube stump 4 months after a laparoscopic salpingectomy for extrauterine pregnancy. She started treatment with methotrexate; afterwards serum human chorionic gonadotropin levels and ultrasound follow‐ups were scheduled. While serum human chorionic gonadotropin levels were progressively reducing, transvaginal ultrasound follow‐ups showed a persistent anechoic mass on right rube stump, with increased peripheral high flow vascularity: highly suspicious for a uterine arteriovenous malformation. A laparoscopy was performed with a tumorectomy of the mass. The histopathological exam of the specimen confirmed uterine arteriovenous malformation. Patient successfully became pregnant 2 years later, with an eventless pregnancy and a vaginal delivery without complications.

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Section: Discussionmentioning

confidence: 58%

Arteriovenous uterine malformation developed from an interstitial pregnancy on residual tubal stump: A critical managment in a fertile woman

Parisi

Garofalo

Alemanno

et al. 2019

J of Obstet and Gynaecol

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“…19 Faioli et al, stated that the Endoloop was a simple and effective technique for laparoscopic management of ectopic pregnancy, both in elective and emergency situations. 35 Conventional electrosurgery includes unipolar and bipolar diathermy. Bipolar cautery is safer than monopolar cautery as the former does not spread the burn to the surrounding structures.…”

Section: Selim and Abdou Discussionmentioning

confidence: 99%

Is Distal Partial Salpingectomy with an Endoloop Ligature Safe, Fast, and Effective for Nonisthmic Tubal Ectopic Pregnancy in Low-Socioeconomic Status Countries?

Selim

Abdou²

2020

Journal of Gynecologic Surgery

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Objective: Total salpingectomy is the ''gold standard'' treatment for tubal ectopic pregnancy. This procedure avoids the risks of persistent trophoblasts and recurrent ipsilateral tubal pregnancies but affects ovarian blood supply. Is distal partial salpingectomy, using an Endoloop Ò Ligature (made with polydioxanone II a, violet monofilament; Ethicon, Somerville, NJ) an easy and fast way to remove the tubal fimbria, without producing a thermal destructive effect? Is the procedure minimally associated with risks of persistent trophoblast and recurrent ipsilateral tubal pregnancies? Should distal partial salpingectomy be recommended for nonisthmic tubal pregnancy, especially in countries of low socioeconomic status? Materials and Methods: In this controlled, comparative observational trial, 54 women with ampullary or fimbrial tubal ectopic pregnancies underwent laparoscopic salpingectomy. The patients were divided into 2 groups of 27 patients each. Group 1 underwent distal partial salpingectomy, using an Endoloop Ligature and group 2 underwent the gold standard total salpingectomy, using bipolar diathermy. Primary outcomes were duration of operative procedure and intraoperative hemoglobin loss; secondary outcomes were recurrent ectopic pregnancy in the ipsilateral tube, persistent trophoblast tissues, and spontaneous intrauterine pregnancy later. Results: Use of an Endoloop Ligature was associated with significantly shorter operating times and less intraoperative hemoglobin loss. No cases of recurrent ectopic pregnancies in the ipsilateral tubes or persistent trophoblast tissues were reported in both studied groups. Seventeen (62.9%) and 16 (59.2%) women achieved spontaneous intrauterine pregnancies during the follow-up period in both groups, respectively. Conclusions: Performing distal partial salpingectomy using an Endoloop Ligature is a safe, rapid, and effective procedure, compared to electrosurgical total salpingectomy. Further studies are still needed to support distal partial salpingectomy as a recommended treatment. ( J GYNECOL SURG 36:120

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“…She had a withdrawal bleeding 3 weeks after the operation and had another period 5 weeks later. A waiting period of at least 6 months [10,11] was advised to allow maximal healing of the uterus. She conceived 8 months after the IP in the first IVF cycle.…”

Section: Two Casesmentioning

confidence: 99%

Elective uterine artery embolization prior to laparoscopic resection of interstitial pregnancy: two cases and literature review

et al. 2018

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Background: Interstitial pregnancies (IP) can be treated medically or surgically. The most common complication remains hemorrhage. The risk of that may be reduced by elective uterine artery embolization (UAE) prior to surgery, which we applied in two consecutive cases with high vascularization on ultrasound. We also reviewed larger series (n ≥ 10) on medical as well as surgical management of IP on success and complication rates and reviewed the entire literature on UAE. Results: A gravida 5 (two ectopic pregnancies treated by salpingectomy) para 1 (cesarean section complicated by a niche, earlier repaired) presented with an asymptomatic IP. Primary treatment consisted of systemic methotrexate (MTX). Because of raising β-hCG and persisting heart activity 1 week later, she was referred for surgery (β-hCG = 59,000 IU/L; CRL = 10.5 mm). Another gravida 5 para 3 presented with an asymptomatic evolutive IP on dating ultrasound. Because of the size (CRL = 24.5 mm), thin overlaying myometrium, and high β-hCG (121,758 IU/L), we opted for primary surgery. Both IPs were highly vascularized with high flow rates. To prevent bleeding, a bilateral UAE was performed. The surgery was nearly bloodless. In the literature, a wide range of treatment regimens for IP is reported. Larger series report a success rate of 76% for primary systemic MTX, 88% for primary local medical treatment, and 94% for primary surgery. It was not possible to determine reliable hemorrhage or rupture rates following MTX administration. As to laparoscopic surgery, the blood transfusion rate for bleeding was 9% while the conversion rate for hemorrhage was 2%. The use of UAE to reduce the risk for hemorrhage before (n = 2) or after (n = 19) MTX administration was reported in 21 cases. This failed in two cases (90% success rate), and one patient required transfusion (5%). Two cases treated with UAE and primary surgery were reported, yet the exact indication for embolization was not elaborated. Alternative hemostatic techniques during surgical management have been proposed to reduce blood loss and operating time, yet individual outcomes were not identifiable. Conclusion: We report on the use of elective UAE prior to laparoscopic resection of IP, because of signs of strong vascularization on ultrasound. This strategy coincided with a nearly bloodless operation. Literature review suggests that this is one of the effective methods to reduce blood loss intra-operatively.

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Endoloop technique for laparoscopic cornuectomy: A safe and effective approach for the treatment of interstitial pregnancy

Cited by 8 publications

References 15 publications

Arteriovenous uterine malformation developed from an interstitial pregnancy on residual tubal stump: A critical managment in a fertile woman

Arteriovenous uterine malformation developed from an interstitial pregnancy on residual tubal stump: A critical managment in a fertile woman

Is Distal Partial Salpingectomy with an Endoloop Ligature Safe, Fast, and Effective for Nonisthmic Tubal Ectopic Pregnancy in Low-Socioeconomic Status Countries?

Elective uterine artery embolization prior to laparoscopic resection of interstitial pregnancy: two cases and literature review

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