Laparoscopic cornual resection is a feasible approach with favorable
surgical and long-term pregnancy outcomes.
|
Compared with laparotomy, laparoscopic cornual section showed shorter
operative time (median 40 vs. 70 min), less blood loss (150 vs. 400 ml)
and shorter hospital stay (2 vs. 4 days).
|
Transvaginal ultrasound scan
|
Laparotomy with cornual resection, (3)
|
Laparoscopic cornual resection, (7)
|
17
|
Patients with intrauterine pregnancy along with feature of a co-existing
interstitial pregnancy:
- A gestational sac visualized high in the fundus.
- not surrounded by 5 mm of myometrium in all planes.
-a gestational sac seen separately and < 1 cm from the most
lateral edge of the uterine cavity.
|
Nanjing Drum Tower Hospital, China.
Records from July 2010 to December 2015
|
Retrospective analysis
|
Jiang 2018 (32)
|
Laparoscopic cornual resection is a safe and less invasive procedure
with a reasonable complication rate and shorter hospital stay.
|
There were no statistically significant differences between the two
groups for the mean operation time, estimated blood loss, blood loss of
more than 1000 mL, blood transfusion requirements, and complications.
The mean number of postoperative hospital days was shorter in the
laparoscopy group than in the laparotomy group (4.53 ± 1.44 days versus
5.89 ± 1.86 days, respectively; P < 0.001).
|
Transvaginal ultrasound scan
|
Open cornual resection, (54)
|
Laparoscopic cornual resection, (34)
|
88
|
Patients with interstitial pregnancy who were treated with open cornual
resection or laparoscopic cornual resection.
|
The Korea University Medical Center, South Korea.
Records from January 1998 to October 2009
|
Retrospective analysis
|
Hwang 2010 (26)
|
Laparoscopic cornual resection (cornuotomy) is a safe and less invasive
procedure with a comparable complication rate. It has shown that it is
feasibility and should be considered as initial treatment in managing
those cases in trained hand surgeons.
|
The duration of hospitalization and mean operating time were both
significantly shorter in the LC group than in the OC group (1.43 ± 0.54
versus 2.57 ± 0.79 and 61.4 ± 15.7 min versus 97.1 ± 38.2 min,
respectively, P < 0.05).There were no statistically
significant differences between both groups for the estimated blood
loss, requirement of blood transfusion, complications, and future
fertility.
|
Physical examination, transvaginal sonography, full blood count, and
serum human chorionic gonadotrophin (hCG) levels.
|
Open cornuotomy, (7)
|
Laparoscopic cornuotomy, (7)
|
14
|
Patients with interstitial pregnancy who were treated with open cornual
resection or laparoscopic cornual resection.
|
Putrajaya Hospital, Putrajaya, Malaysia.
Records from January 2005 to December 2014,
|
Retrospective cohort
|
Ghazali 2018 (27)
|
A change from diagnosis later in pregnancy and laparotomy to more
conservative treatment, mainly by laparoscopy, suggests a possibly
better subsequent
pregnancy rate.
|
The first four women, with significant hemoperitoneum, were treated by
laparotomy. Of
the next 10 women, four were selected for medical treatment with
methotrexate. Only one case was treated successfully. The other six
women had laparoscopic treatment. Of nine laparoscopies, one was
converted to laparotomy due
to excessive blood loss during the procedure. Of nine women desiring a
child, three were infertile, whereas six conceived with an intrauterine
pregnancy.
|
Transvaginal ultrasound scan
|
Laparotomy, (5)
|
Laparoscopy cornuostomy, encircling, or salpingectomy, (8)
|
14
|
Patients with interstitial pregnancy who were treated with laparotomy,
medical treatment with systemic methotrexate, or laparoscopy.
|
Wolfson Medical Center, Holon, and 2Sackler Faculty of Medicine,
Tel-Aviv
University, Tel-Aviv, Israel.
Records from June 1997 to June 2007.
|
Retrospective cohort
|
Sagiv 2013 (22)
|
Ipsilateral salpingectomy, previous ectopic pregnancy, and in vitro
fertilization are predisposing factors for interstitial pregnancy.
Contrary to previous belief, rupture of interstitial pregnancy occurs
relatively early in pregnancy. In selected patients, laparoscopic
cornual excision is a viable treatment option.
|
Persistently elevated serum human chorionic gonadotropin levels were
found in one patient after laparoscopic cornual excision, and she was
successfully treated with methotrexate. Fourteen cases (43.7%) of
rupture of interstitial pregnancy were found. This included five cases
(15.6%) of heterotopic pregnancy; all were the results of in vitro
fertilization, and all ruptured at the time of diagnosis. Subsequent
pregnancy was achieved in ten
patients. No uterine rupture was encountered during pregnancy or
labor
|
Transvaginal ultrasound scan and diagnostic laparoscopy and
laparotomy.
|
Laparotomy, (13)
|
Laparoscopy, (11)
|
32
|
Patients with interstitial pregnancy who were treated with laparotomy,
methotrexate, or laparoscopy.
|
-
Cases from 1999 to 2002.
|
Cross sectional
|
Tulandi 2004 (23)
|
Progressively conservative surgical measures are being used to treat
interstitial pregnancy successfully, with no negative impact on
subsequent pregnancies. |
Subsequent successful reproductive outcomes
are presented. |
Transvaginal ultrasound scan and diagnostic laparoscopy |
Cornuostomy by laparotomy, (1) |
Laparoscopic cornuostomy and removal
of products of conception, (3) |
4 |
Cases of interstitial ectopic
pregnancy |
- |
Case series |
Warda 2014 (24) |