Operative laparoscopy for the treatment of ectopic pregnancy in a residency program

OBJECTIVE: To compare the effectiveness and safety of operative laparoscopy (OL) when used for the treatment of ectopic pregnancy in the setting of a residency training program. STUDY DESIGN: We retrospectively reviewed records of all patients with diagnostic laparoscopy documenting the presence of an ectopic pregnancy. Patients who met the following criteria were selected: hemodynamic stability, tubal distortion no greater than 5 cm and adequate visualization of the pelvis. The cases performed via OL were compared to the cases performed via laparotomy (LAP). All the surgery had been performed by resident physicians with the attending gynecologist as first assistant/supervisor. RESULTS: Ninety-five cases performed from March 1989 to April 1992 met the above criteria. Group 1 consisted of 61 patients treated with LAP. Group 2 consisted of 34 patients treated with OL. The operating time (76.8 +/- 19.0 vs 76.0 +/- 23.0 min, mean +/- SD) and he estimated blood loss (275.0 +/- 183.7 vs 70.5 +/- 75.2 ml) were similar for both groups. The hospital stay for the LAP group was longer than for the OL group (3.7 +/- 1.2 vs. 1.4 +/- 0.6 days, P < .001). The surgical complication rate was also higher in the LAP group (23% vs 2.9%, P = .016). CONCLUSION: In our residency program the introduction of OL for the management of ectopic pregnancy has resulted in shorter hospital stays and lower morbidity without increased duration of the surgical episode or increased blood loss.