Laparoscopic approach to cornual ectopic: a step-by-step demonstration

Objective: To concisely review what is known about cornual ectopic pregnancies and to provide a step-by-step demonstration of the resection of a large cornual ectopic pregnancy, highlighting various laparoscopic techniques. Design: A video review of cornual ectopic pregnancy and a laparoscopic approach for treatment featuring a patient case at 9 weeks gestation. Setting: Tertiary care facility. Patients: A 31-year-old G2P1001 at 9 weeks 0 days by transvaginal ultrasound and with a beta human chorionic gonadotropin of 13,099 presented to the emergency department for vaginal bleeding and cramping left lower quadrant pain. She was hemodynamically stable. Her ultrasound was suspicious for a cornual ectopic pregnancy, which was confirmed by magnetic resonance imaging. Interventions: The patient was taken to the operating room for resection, given the size of the pregnancy, concern for intraoperative blood loss, concern for persistent pregnancy, and concern that patient would not be able to reliably follow up for multiple appointments. Patient underwent laparoscopic resection of a large cornual ectopic pregnancy. Included is a short review of laparoscopic suturing techniques. Main Outcome Measures: Pathology, decline in beta hCG, and post-operative course. Results: The patient's pathology was confirmatory for cornual ectopic pregnancy. Her beta human chorionic gonadotropin decreased as expected, and she had a normal post-operative course. Conclusions: Laparoscopic cornual resection is a safe and effective method for management of large cornual ectopic pregnancy, and fertility outcomes are similar to patients after salpingectomy for non-interstitial ectopic pregnancy. (Fertil Steril (R) 2019; 112: 397-8. (C) 2019 by American Society for Reproductive Medicine.)