Laparoscopic-assisted instillation of epinephrine and levobupivacaine enables cornual excision and anatomical reconstruction in unruptured cornual pregnancy

Abstract

The objective of this report is to describe the possible use of intramiometrial vasoconstrictive agents for laparoscopic management of interstitial pregnancy and the consequences in anatomical results and reproductive outcomes. Cornual resection can be performed by laparoscopy, but the high vascularization of this area may result in profuse bleeding and laparoscopic suturing under these conditions might be impossible for the majority of the surgeons. We present a case that describes the possible use of intramiometrial instillation of a solution of diluted epinephrine and levobupivacaine under laparoscopic guidance that permitted a bloodless cornual excision with complete reconstruction. Vasoactive agents might have potentially serious cardiovascular side effects and the correct election of the active principle and the dosage is essential to reduce the risk of the surgery and obtain good anatomical results and reproductive outcomes. In conclusion, unruptured interstitial pregnancies can be managed successfully with intramyometrial instillation of epinephrine and bupivacaine. This simple technique is particularly attractive as it facilitates anatomical reconstruction of the cornual area, gives enough time to perform a complete suture of the defect and reduces the risk of laparotomic conversion.

Minimizing bleeding in laparotomic myomectomy: A comparative study

“…Similar works were conducted by Zullo et al, who used bupivacaine plus epinephrine during Laparoscopic myomectomy, and Gilabert-Estelles et al, who used epinephrine and levobupivacaine in cornual pregnancy to reduce blood loss. 14,15 Some published data from Fletcher et al, Helal et al, and Ikechebelu et al, who used Foley's catheter as a uterine tourniquet during myomectomy, however, and to our knowledge, our work was unprecedented to compare tourniquet using Foley's catheter versus intra-myometrial injection of bupivacaine plus epinephrine in reducing blood loss in abdominal myomectomy. [16][17][18] Ikechebelu et al, however, concluded that the use of tourniquet might be limited with large cervical or intra-ligamentry fibroids.…”

Effect of intramyometrial injection of epinephrine during abdominal myomectomy

“…Review of literature revealed two studies investigating the use of bupivacaine plus epinephrine during gynaecological operations. The first was carried out by Zullo et al [12] who used bupivacaine plus epinephrine during laparoscopic myomectomy, while Gilabert-Estelles et al [20] tested the use of epinephrine and levobupivacaine in laparoscopic excision and reconstruction of intact cornual ectopic pregnancy.…”