Minimally invasive surgical management of a cornual ectopic pregnancy, with and without a concurrent intrauterine pregnancy.

OBJECTIVE: To describe techniques for resection of a cornual heterotopic pregnancy. DESIGN: This video demonstrates a surgical technique for excision of a cornual heterotopic pregnancy with narrative video footage using two case examples. SETTING: The incidence of cornual heterotopic pregnancy is unknown; however, the incidence of heterotopic pregnancy itself has increased through the use of assisted reproductive technologies and the majority of cornual heterotopic pregnancies occur after assisted reproductive technologies use. These cases have been treated traditionally using exploratory laparotomy and cornual wedge resection with good outcomes. With advancements in minimally-invasive surgical techniques, laparoscopic resection of cornual heterotopic pregnancies has been demonstrated to be safe and feasible. PATIENT(S): A patient with an 8-week cornual heterotopic pregnancy and a patient with a 10-week cornual ectopic pregnancy. INTERVENTIONS: Laparoscopic resection of the cornual ectopic pregnancy. MAIN OUTCOME MEASURE(S): Feasibility of a "purse-string" technique for the resection of a heterotopic cornual pregnancy. RESULT(S): Robotic-assisted laparoscopic resection of a cornual heterotopic pregnancy can be performed with minimal blood loss with the use of the "purse-string" technique in settings where vasopressin cannot be used for hemostasis. This technique includes the use of a 2-0 V-Loc suture in a circumferential fashion around the ectopic pregnancy, which allows for faster suturing and immediate tension at the myometrium. The same suture is then used to close the defect, which allows for a simpler and efficient closure with minimal entry into the myometrium. CONCLUSION(S): In this video, we demonstrate the successful resection of cornual heterotopic pregnancy using a "purse-string" surgical technique. This technique allows for minimal blood loss in cases where additional techniques for hemostasis cannot be used, such as injection of vasopressin and uterine artery ligation.

Successful management of heterotopic cornual pregnancy with laparoscopic cornual resection.

OBJECTIVE: To examine the feasibility of laparoscopic cornual resection for the treatment of heterotopic cornual pregnancy. STUDY DESIGN: Women who underwent laparoscopic cornual resection for heterotopic cornual pregnancy at our hospital between January 2003 and March 2015 were retrospectively analyzed. We evaluated significant parameters such as operative complications and postoperative pregnancy outcomes of concomitant pregnancy. RESULTS: Thirteen patients with heterotopic cornual pregnancy were included in the study. All were pregnant through assisted reproductive technology, and the diagnosis was made at a median of 6+6 weeks (range 5+4-10+0). They were successfully treated with laparoscopic cornual resection and admitted for a median of 4 days (range, 2-7) postoperatively. The median operative time was 65min (range, 35-145min) and estimated blood loss was 200mL (range, 10-3000mL). There was a spontaneous abortion at 7+6 gestational weeks in a patient who received bilateral cornual resection. Seven patients delivered babies at term and 3 at preterm. All 10 women delivered without any maternal or neonatal complications. Two were lost to follow-up. CONCLUSIONS: Laparoscopic cornual resection is a feasible primary approach for the management of heterotopic cornual pregnancy.