A simple and safe surgery for unruptured ectopic pregnancy: A laparoscopy-assisted extraabdominal surgical technique

As an alternative procedure to standard laparoscopic surgery for unruptured ectopic pregnancies, we describe a simple and safe laparoscopy-assisted technique without using special instruments. Under laparoscopic guidance, the contents of the swollen part of the tube, such as amniotic fluid or blood clots, are aspirated as much as possible by a 19-gauge metal needle through the abdominal wall to minimize the sectional area of the tube. The tube with the gestational tissues is pulled out to the skin surface through the suprapubic hole of a trocar with a complete desufflation of CO2 gas, which is the important component of this technique. Once the tube is exteriorized, any extraabdominal surgery can be performed safely under direct vision. This operation was performed on 13 consecutive patients with unruptured ectopic pregnancies. Although the mean duration of the operative procedure was 87 +/- 46 min in 8 patients without pelvic adhesion, it was 121 +/- 26 min in 5 patients with various degrees of adhesion, which usually required the additional widening of the puncture hole of a trocar up to 2 cm in width. No patients undergoing laparoscopy-assisted extraabdominal salpingostomy or salpingectomy were treated for persistent ectopic pregnancy. Several advantages and disadvantages of this procedure are discussed.