Journal of Minimally Invasive Gynecology
Journal of Minimally Invasive Gynecology
5 years ago

Temporary Simultaneous Two-Arterial Occlusions (Testo) during Laparoscopic Management for Cornual Ectopic Pregnancy

To demonstrate a new technique of TEmporary Simultaneous Two-arterial Occlusions (TESTO) of uterine and ovarian (or utero-ovarian) artery to reduce operative blood loss during laparoscopic cornual resection for cornual ectopic pregnancy. Design A step-by-step explanation of the surgical procedure using video (Canadian Task Force classification III). This study was approved by the Institutional Review Board. Setting A university hospital Patients A 41-year-old woman presented with pelvic pain with 7 weeks of amenorrhea. Transvaginal sonogram and laboratory test revealed left cornual pregnancy. She had a history of left salpingectomy due to tubal pregnancy and wanted prompt surgical management without surgical scar. Intervention At the single-port laparoscopy, we found a 3-cm unruptured ectopic mass in the left uterine cornua. In the first step, the retroperitoneum was opened by Harmonic Scalpel (Ethicon Endosurgery, Cincinnati, OH, USA) along infundibulopelvic ligament. Then, both uterine arteries were temporarily occluded with bulldog clamp (Aesculap, Tuttlingen, Germany) at the level where it originates from the internal iliac artery. The bulldog clamp, which is a spring-loaded crossover clamp with serrated blades effectively occlude vessels without slippage or significant crush injury, is the laparoscopic instrument for minimizing blood loss during surgical procedure. Each ovarian arterial vasculature was also transiently occluded at the utero-ovarian or ovarian pedicle with placing bulldog clamp. Uterine incision then was made in the left cornua using Harmonic Scalpel, and the gestational conception was expressed through the incision and corneal resection was completed. The uterine defect was closed using V-Loc suture (Covidien, Mansfield, MA, USA). In the final step, all vascular clamps were removed for reperfusion. Measurements and Main Results Operative time was 45 minutes. The procedure time for TESTO and the occlusion time (defined as the time that bilateral uterine and ovarian vessels were occluded by bulldog clamps) were 10 and 12 minutes, respectively. Estimated blood loss was 50mL, and her post-operative hemoglobin was 11.9 g/dL from 13.0 preoperatively. No complications occurred in the postoperative course. Her menstruation resumed 2 months after surgery. Conclusion Surgical management of ectopic cornual pregnancy could be performed safely and efficiently under laparoscopy with the TESTO technique. Large scale comparative study was warranted for confirmation of our report.

Publisher URL: www.sciencedirect.com/science

DOI: S1553465018300463

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