The Fallopian tube is the commonest site of an ectopic pregnancy. Other sites include the ovary, cervix, a scar of a previous cesarean section and, very rarely, other abdominal organs (intestines, spleen, etc.)
Laparoscopic surgery is the gold standard for management of ectopic pregnancy. Even with the most extreme blood loss, laparoscopic surgery is superior to conventional open surgery since it involves small incision with virtually no bleeding, rapid removal of the ectopic or the affected organ, better maintanence of blood supply to the brain of the woman (since the increased pressure in the abdomen diverts blood away from the abdominal organs to other areas) and, naturally, faster and painless recovery.
The following surgeries can be performed by endoscopy:
Salpingectomy : If the ectopic pregnancy has eroded the wall of the Fallopian tube or if the ectopic pregnancy is extremely large or the Fallopian tube is diseased, the Fallopian tube can be excised via laparoscopy.
Salpingostomy : In case of a small, unruptured ectopic pregnancy or a healthy Fallopian tube, the ectopic pregnancy can be extracted with a small cut on the Fallopian tube. The cut can be sutured with fine sutures or left to heal naturally.
Oophorectomy or excision of ovarian ectopic pregnancy : A pregnancy implanted on the ovary can be excised or, in case of a large or actively bleeding ectopic pregnancy, an oophorectomy (removal of the ovary) performed.
Excision of scar ectopic : A pregnancy can implant into the scar of a previous cesarean section. This can erode into the urinary bladder or cause massive bleeding and death. The ectopic pregnancy can be excised and the cut in the uterus sutured. In extreme cases, with massive bleeding, a hysterectomy may be necessary.
Hysteroscopic removal of cervical ectopic pregnancy : A cervical ectopic pregnancy is a pregnancy implanted on the mouth of the uterus (cervix). This is an extremely dangerous or life threatening condition since the pregnancy can be mistaken for a miscarriage and life threatening hemorrhage can ensue. With modern technology, the pregnancy can be excised with a small telescope placed in the uterine cavity using a electrode. The bleeding vessels can be directly cauterized under vision.
Advantages of laparoscopy for management of ectopic pregnancy include:
- Significantly less blood loss
- Rapid recovery with virtually no pain
- Low risk of post-operative adhesions and hernia
- Better clearance of free blood in the abdominal cavity with reduced pain post-operatively