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| Name | Laparoscopic Approach to Conservative Management of Ovarian Ectopic Pregnancy |
| Video Uploader | Video From CanSAGE Secretariat |
| Upload Date | This Video Uploaded At 07-02-2024 19:30:48 |
| Video Discription | Presented By Dr. Jazleen Dada Dr. Jamie Kroft Affiliations University of Toronto See full transcript here: www.cansagevideos.com/laparoscopic-approach-to-conservative-management-of-ovarian-ectopic-pregnancy/ Laparoscopic approach to conservative management of ovarian ectopic pregnancy. This method demonstrates a conservative approach to successful removal of ovarian ectopic that maximises future ovarian function and fertility by preserving ovarian tissue, limiting the need for oophorectomy. Ovarian ectopic pregnancy is rare. Reported incidents after natural conception ranges from one in 7000 to one in 40000 natural pregnancies, and accounts for 3% of all ectopic pregnancies. However, there are reports of an increase in incidents relative to both tubal and term pregnancies. In contrast to tubal pregnancy, there is a lack of consensus on aetiology. Ovarian pregnancy is neither associated with pelvic inflammatory disease or infertility. Few to no reported cases of recurrent ovarian pregnancy suggests this may be a chance phenomenon. The most common associated risk factor is use of intrauterine device, but increasing incidents with infertility and assisted reproductive technologies is now being reported. Presenting signs and symptoms of this conditions minimally deviate from that of the typical presentation of tubal or rupture of tubal ectopic, which can make establishing the diagnosis challenging. Approximately 75% of cases will terminate in the first trimester, and are often misdiagnosed as corpus luteal haemorrhage or ovarian cyst, unless they undergo early ultrasound and beta-hCG for symptomatic pelvic pain. Sonographic diagnostic criteria on ultrasound that have been suggested include wide echogenic ring, internal echo on the ovarian surface, presence of ovarian cortex around the mass, and echogenicity of the ring greater than that of the ovary itself, or ring of fire sign. For those who present with rupture and haemodynamic instability, preoptic diagnosis is not easily made with imaging. It is twice as likely to be diagnosed at surgery, mostly incidentally at the time of presumed tubal ectopic, or following the pathological diagnosis. Spiegelberg criteria were developed in attempt to establish diagnosis. These criteria, however, still often fail to be satisfied by known cases. Therefore, the diagnosis is frequently clinically based on location of pregnancy at the time of removal. As most patients present with a ruptured sack in a haemodynamically compromised state, medical management is usually not feasible. Ovarian ectopic pregnancy can be broadly classified into two types, intra and extraovarian. A plane of division may be found between the ectopic pregnancy and the ovary in an extraovarian, allowing for its excision, unlike the intraovarian type, which may need wedge resection, or even oophorectomy. Steps to the procedure in a stepwise approach include, number one, confirming the diagnosis. Following entry into the abdomen, evacuation of hemoperitoneum, and visualisation of ovarian ectopic to confirm diagnosis as intra or extraovarian pregnancy. Number two, incision and dissection. The creation of a linear oophorostomy and careful tissue dissection. Number three, ensuring adequate haemostasis. Number four, removal. Retrieval of the specimen, and closure. We present a case of an otherwise healthy 33-year-old G2 P1 patient at approximately eight weeks gestation by last menstrual period. She spontaneously conceived, and presented with severe pelvic pain to the emergency room. Vitals are within the normal limits. Examination findings are pertinent for severe rebound tenderness. Her haemoglobin is 97 from a baseline of 120, and her beta-hCG is 3240. Ultrasound findings revealed no evidence of an intrauterine pregnancy. Hemoperitoneum, and vascular ring-shaped structure of 1.9 by 1.7 cm thick walled, inseparable from right ovary, with peripheral flow. Not typical for tubal pregnancy, and differential would include haemorrhagic cyst. Intraoperative findings were as follows. Following abdominal entry with a Veres needle technique and placement of intraabdominal ports, hemoperitoneum was evacuated with a large suction irrigator for 700 ml of blood, for ease of evacuation through a 12 mm right lower quadrant port. Careful examination of the pelvis was conducted for any signs of ongoing bleeding or haemorrhage. Findings included right ovarian ectopic pregnancy about 2 cm in size, otherwise normal fallopian tubes and contralateral left ovary. Diagnosis was confirmed, and the decision was made to proceed with conservative management, with linear oophorostomy in order to preserve the ovary. With the monopolar scissors and electrocautery, we incised the overlying ovarian tissue to extend the ectopic pregnancy opening laterally by approximately 2 cm. |
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