Operative Laparoscopy as the Mainstay Method in Management of Hemodynamically Unstable Patients with Ectopic Pregnancy

Odejinmi, Funlayo; Sangrithi, Mahesh N.; Olowu, O.

doi:10.1016/j.jmig.2010.11.005

Cited by 32 publications

(22 citation statements)

References 18 publications

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“…The RCOG Guidelines quotes only grade C evidence obtained from expert committee reports or opinions [21]. However, there is now increasing evidence to suggest that better availability of blood and blood components, optimal anaesthesia and surgical skills have made laparoscopy not only feasible to use on haemodynamically unstable patients but also safe [10,11,22,23]. …”

Section: Discussionmentioning

confidence: 99%

“…Limiting factors to OL are related to the location of the EPs (i.e. non-tubal EPs require more surgical expertise), lack of 24 h availability of OL equipment, poor surgical training [9] and the haemodynamic status of patients [10,11]. Moreover, non-tubal EPs (i.e.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, non-tubal EPs (i.e. ovarian and cornual pregnancies), which account for up to 5% of EPs [10], have a high incidence of late presentation and misdiagnosis [12,13]. They also have a greater risk of presenting after rupture and together with the greater surgical expertise required increase the likelihood of laparotomy.…”

Section: Introductionmentioning

confidence: 99%

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Beyond Guidelines: Effectiveness of a Programme in Achieving Operative Laparoscopy for all Women Requiring Surgical Management of Ectopic Pregnancy

Odejinmi

Rizzuto²,

Oliver

et al. 2015

Gynecol Obstet Invest

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Background/Aims: Operative laparoscopy (OL) is considered the gold standard surgical treatment of ectopic pregnancy (EP). We questioned whether a training programme to foster OL treatment is able to ensure that all women needing surgical management are treated by OL irrespective of the site of EP, haemodynamic status and clinical complexity. Methods: A 13-year cohort study of 963 women who underwent surgical management was conducted. We instituted a ‘universal OL' programme in 2003 for the management of all the types of EP irrespective of the haemodynamic status. Results: There were 802 women in the prospective (2003-2013) and 161 in the retrospective arm (2000-2002). The rate of OL before 2003 was 34%. During the year of programme implementation, the OL rate rose from 89% in 2003 to 96% in 2004. It took 4 years to achieve a 100% OL rate in haemodynamically stable patients. In 2013, we were able to achieve OL treatment for all patients irrespective of haemodynamic status, the complexity of surgery or the location of EP. Conclusion: Our study demonstrates that a dedicated team with special training in minimal invasive surgery can improve surgical management of all categories of EPs, and this goal should be achievable across most units.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Beyond Guidelines: Effectiveness of a Programme in Achieving Operative Laparoscopy for all Women Requiring Surgical Management of Ectopic Pregnancy

Odejinmi

Rizzuto²,

Oliver

et al. 2015

Gynecol Obstet Invest

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“…Odejinmi et al reported that operative laparoscopy is safe and sustainable in most women with ectopic pregnancies with hemodynamic instability, but the procedure requires substantial laparoscopic skill. 12 With respect to the prognosis of intrauterine pregnancy, favorable outcomes are reported in 66% of cases of heterotopic pregnancies treated mainly by surgery. 8 In the last couple of decades, conservative nonsurgical treatment such as local injection of potassium chloride or methotrexate has been selected as an alternative treatment for unruptured heterotopic pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Surgery for Heterotopic Pregnancies: Two Cases

ChaeHeesuk

KimSunyoung

JeongYoungju

et al. 2014

Journal of Gynecologic Surgery

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Background: Heterotopic pregnancy is a rare clinical condition, but it is increasingly being diagnosed after the common use of ovarian stimulation and the advent of assisted reproductive techniques. Two cases of heterotopic pregnancy, successful laparoscopic removal of one ectopic pregnancy, and a subsequent favorable outcome of the intrauterine pregnancy, are presented. Cases: The first case was associated with ovarian hyperstimulation syndrome following in vitro fertilization and embryo transfer, and the second case occurred after intrauterine insemination. Results: Via laparoscopy, both cases were diagnosed with ruptured tubal ectopic pregnancy, and laparoscopic salpingectomy after evacuation of the hemoperitoneum was performed. The first patient, at 39 and 1/7 weeks of gestation, was delivered of healthy newborn, weighing 3910 g. In the second patient, at 9 and 4/7 weeks of gestation, an ultrasound scan confirmed a viable intrauterine pregnancy. Since then, the patient has been lost to follow-up. Conclusions: Laparoscopy allows for both a differential diagnosis in an uncertain condition during pregnancy, and a favorable outcome of an intrauterine pregnancy. In the light of this, laparoscopy may be the treatment of choice for patients with heterotopic pregnancies. ( J GYNECOL SURG 30:305)

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“…One study even suggests equivalent outcomes in the hemodynamically unstable patient [ 31 ], long considered an absolute contraindication to laparoscopy. There are, however, special patient populations and situations to consider.…”

Section: Special Patient Populationsmentioning

confidence: 99%

Perioperative Assessment

Kvasnovsky

Bafford²

2014

Minimally Invasive Approaches to Colon and Rectal Disease

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Key Points• Pneumoperitoneum leads to increased cardiac preload and afterload, hypotension, increased airway pressures, increased end-tidal CO 2 , and decreased urine output.• Laparoscopic colorectal surgery is associated with decreases in postoperative pain, ileus, length of hospital stay, and wound complications, and improved cosmesis when compared to open surgery.• Oncologic outcomes and IBD recurrence rates are similar after laparoscopic and open colectomy.• Routine laboratory studies are recommended prior to laparoscopic colorectal surgery. More intensive cardiopulmonary testing should be reserved for symptomatic patients and those with signifi cant risk factors.• Laparoscopic surgery can be safely performed in elderly and obese patients as well as in certain cases of emergency and reoperative surgery.• Bowel preparation should generally be used in order to improve maneuverability of the bowel and to allow for intraoperative endoscopy.• Colorectal tumors should be localized with 4-quadrant tattooing and Crohn's lesions with imaging and endoscopy prior to surgery.• Patients should be securely positioned with arms tucked and legs apart (for left colon and rectal procedures).• Judicious fl uid administration, early feeding and mobilization, and minimization of narcotics should be part of postoperative care. Physiologic Effects of LaparoscopyPneumoperitoneum is the sine qua non of laparoscopic surgery. Insuffl ation of the abdomen has both mechanical and physiologic effects. These changes become especially relevant in colorectal surgery, where positioning varies steeply over the course of operations. Colorectal operations may also be prolonged, which can further amplify effects. Although less than ideal, carbon dioxide (CO 2 ) is currently the primary gas being used in laparoscopic surgery. The ideal gas would be noncombustible, colorless, and have limited physiologic effects. Because electrocautery is commonly used in laparoscopic surgery, combustible gases are absolutely contraindicated [ 1 ]. This precludes the use of oxygen, room air (which is 21 % oxygen), and nitrous oxide. Meanwhile, helium and argon as inert gases would fulfi ll the requirement of nonfl ammability; however, they have lower thresholds for toxicity. CO 2 remains the gas of choice. Transperitoneal absorption of CO 2 results in increased dissolved CO 2 in the blood, which can create a mild acidosis and hypercapnia.Pneumoperitoneum causes further physiologic effects that may infl uence decision-making in colorectal surgery. The majority of these changes will be well tolerated in ASA I and II patients (Table 1.1 ). For those with higher ASA grades, the effect is highly variable and often more problematic. Cardiovascular EffectsThere are many cardiovascular and hemodynamic changes during laparoscopic surgery as well as concomitant changes with positioning (Table 1.2 ). These do not usually affect

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Operative Laparoscopy as the Mainstay Method in Management of Hemodynamically Unstable Patients with Ectopic Pregnancy

Cited by 32 publications

References 18 publications

Beyond Guidelines: Effectiveness of a Programme in Achieving Operative Laparoscopy for all Women Requiring Surgical Management of Ectopic Pregnancy

Beyond Guidelines: Effectiveness of a Programme in Achieving Operative Laparoscopy for all Women Requiring Surgical Management of Ectopic Pregnancy

Laparoscopic Surgery for Heterotopic Pregnancies: Two Cases

Perioperative Assessment

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