Laparoscopic operation with ectopic pregnancy

Ectopic pregnancy occurs when the implantation of a fertilized egg happens outside the uterus, most commonly in the fallopian tubes. Statistically, its frequency is 1-2% of all pregnancies. As the embryo grows, life-threatening conditions for the woman may arise, such as a ruptured tube and bleeding. Therefore, it is crucial to diagnose and provide surgical treatment in a timely manner. Laparoscopic surgeries for ectopic pregnancies are performed at the "Dobrobut" Medical Center.

Causes of Ectopic Pregnancy Can Include:

• Inflammation and/or adhesions in the fallopian tubes, which may hinder the movement of the fertilized egg to the uterus.
• Hormonal imbalance that may affect the proper development of the fertilized egg.
• Previous surgeries or infections of the pelvic organs.
• Pregnancy occurring with an intrauterine device (IUD) in place.
• Smoking.

Symptoms of Ectopic Pregnancy

Signs of ectopic pregnancy may include:

• Sharp, stabbing, cutting pain in the abdomen or pelvis;
• Bleeding: from light to heavy vaginal bleeding, which may be constant or intermittent;
• Weakness, dizziness, or fainting as symptoms of low blood pressure due to internal bleeding;
• Pressure or pain in the rectal area.

If such symptoms appear, it is essential to urgently consult a doctor, as the condition can be life-threatening and requires immediate medical help.

Indications for Laparoscopy in Ectopic Pregnancy

One of the most effective intervention methods for ectopic pregnancy is laparoscopic surgery.

Indications for laparoscopy include:

• Suspected ectopic pregnancy: relevant clinical presentation or confirmation through diagnostic tests (ultrasound and blood tests);
• Signs of rupture of the ectopic pregnancy;
• Progressive ectopic pregnancy:
• Severe bleeding, signs of shock, or intense pain.

Contraindications to Laparoscopy for Ectopic Pregnancy May Include:

• Critical condition of the patient with unstable vital signs, in which case open abdominal surgery (laparotomy) is more commonly performed.
• Severe adhesions and extensive scarring in the abdominal cavity that may complicate laparoscopic surgery.
• The decision to pursue another treatment option.

The decision to perform laparoscopy for ectopic pregnancy is based on a careful assessment of each individual case, weighing the benefits of minimally invasive surgery against potential risks and contraindications.

Advantages of Laparoscopy in Ectopic Pregnancy

Laparoscopic surgeries are currently the preferred method, as they have a number of advantages over open surgical procedures:

• Laparoscopy is a minimally invasive surgical procedure that involves small incisions, leading to less postoperative pain, reduced scarring, and faster recovery compared to traditional laparotomy.
• Reduction in hospital stay.
• Quicker recovery.
• Improved visualization: the surgeon receives an enlarged view of the pelvic organs in real time, which enhances visualization and accuracy during the removal of the ectopic pregnancy.
• Decreased risk of complications such as postoperative infections, blood loss, and adhesions.
• Cosmetic benefits: smaller incisions used during laparoscopy result in less noticeable scars.
• Diagnostic capabilities: laparoscopy not only allows for the removal of ectopic pregnancies but also helps identify any other abnormalities.

Types of Laparoscopy for Ectopic Pregnancy

In cases of ectopic pregnancy, several types of laparoscopic procedures may be performed, depending on the individual characteristics of the patient, as well as the location and severity of the ectopic pregnancy. The most common procedures include:

• Salpingostomy - involves a small incision in the fallopian tube to remove the ectopic pregnancy while preserving the tube itself.
• Salpingectomy - indicated when the fallopian tube is severely damaged or when future fertility issues are not a priority; it involves the complete removal of the affected fallopian tube.
• Linear salpingostomy with a linear incision on the fallopian tube when traditional salpingostomy is not possible or advisable.
• Segmental resection - performed in complex cases where the ectopic pregnancy is localized to a specific segment of the fallopian tube.

The specific type of laparoscopy depends on factors such as the location of the ectopic pregnancy, the condition of the fallopian tube, the reproductive plans of the patient, and the experience of the surgical team.

How Laparoscopy for Ectopic Pregnancy is Performed

The procedure is typically performed under general anesthesia. After preparing the surgical field, the surgeon makes a small incision near the navel (umbilicus) and introduces a thin tube (trocar) through which carbon dioxide is insufflated into the abdominal cavity.

Next, a laparoscope (a thin tube with lighting and a camera) is inserted to visualize the pelvic organs, including the fallopian tubes, ovaries, and uterus, with the enlarged image displayed on a monitor in the operating room.

One or more additional small incisions may be made on the abdomen to introduce specialized surgical instruments. The surgeon carefully examines the fallopian tubes to determine the localization of the ectopic pregnancy or the site of the tube rupture. After safely removing the ectopic pregnancy, all bleeding vessels are cauterized or sutured. The instruments are removed, and small incisions are closed with sutures or surgical tape.

Rehabilitation After Laparoscopy for Ectopic Pregnancy

The rehabilitation period may vary depending on the type of intervention and the clinical situation, but general recommendations for postoperative care and recovery are as follows:

1. Early Postoperative Period:
   • Immediately after surgery, patients are typically monitored in the intensive care unit until they fully regain consciousness and their condition is assessed as stable.
   • Analgesics may be prescribed during this period.
   • Patients may experience pain or abdominal bloating due to residual carbon dioxide in the abdominal cavity, which should subside within a day or two.
2. Late Postoperative Period:
   • Patients are discharged to home care, advised to avoid strenuous activity, lifting heavy objects, or driving;
   • It is important to follow the surgeon's instructions regarding wound care, such as keeping incision sites clean and dry;
   • A follow-up appointment is necessary a few days later.
3. Physical Activity:
   • Light activity, such as walking, is recommended as it promotes better circulation and accelerates recovery.
   • It is advisable to avoid heavy physical exertion or lifting weights for at least two weeks to allow the body to recover.
4. Nutrition:
   • A healthy diet rich in fruits, vegetables, and lean proteins is recommended.
   • It is important to ensure adequate fluid intake.
5. Subsequent Care:
   • It is crucial to attend all scheduled follow-up appointments to monitor the recovery process and timely diagnose any complications.

Laparoscopy for ectopic pregnancy is minimally invasive, resulting in smaller incisions, reduced postoperative pain, and faster recovery compared to traditional open surgery. The qualified surgical team at the “Dobrobut” Medical Center, which has extensive experience performing gynecological procedures, ensures the implementation of techniques and patient safety throughout the process, as well as quicker recovery and lower risk of complications.