Technique for the Laparoscopic Management of a Cornual Ectopic Pregnancy.

STUDY OBJECTIVE: To describe a technique for the laparoscopic management of a cornual ectopic pregnancy.

DESIGN: Step-by-step explanation of the procedure using video (Canadian Task Force classification III).

SETTING: Cornual pregnancy is a rare form of ectopic pregnancy, accounting for up to 2% to 4% of all ectopic pregnancies, with a mortality range of 2.0% to 2.5%, and this accounts for 20% of all deaths caused by ectopic pregnancies. Both medical and surgical treatments have been reported. Although laparotomy hysterectomy and cornuectomy used to be the preferred surgical approaches, more cornual ectopic pregnancies are being managed with the laparoscopic approach through cornuostomy or cornuectomy in recent years. The main concern with surgical treatment is hemorrhage and the need for cornual reconstruction, which necessitate advanced laparoscopic skills and technique.

INTERVENTIONS: In this video, we describe our technique for the treatment of a cornual ectopic pregnancy. We present the case of a 21-year-old G3P2002 (gravida 3 para 2002) with the finding of a right live cornual ectopic pregnancy with gestational age of 6 weeks on pelvic ultrasound along with an elevated human chorionic gonadotropin level at 7,192 and right pelvic pain. After counseling regarding treatment options, the patient agreed with proceeding with surgery and underwent a laparoscopic right cornuectomy. Her surgery was uneventful, and she was discharged home a few hours after surgery. She was completely recovered at her postoperative follow-up visit. Her serial serum human chorionic gonadotropin levels were followed until complete resolution a few weeks later.

CONCLUSION: Laparoscopic cornuectomy is a safe and effective procedure for the management of cornual ectopic pregnancy. The use of hemostatic agents and suturing can help prevent hemorrhage and allows a safe removal of the ectopic pregnancy and repair of the uterine defect created.