Laparoscopy and minilaparotomy as operative management of ectopic pregnancy

The widespread use of serum human chorionic gonadotropin (hCG) monitoring has enabled earlier diagnosis of ectopic pregnancy and increasingly conservative methods of management including operative laparoscopy, medical therapy with methotrexate, and expectant management. We investigated the use of a combined laparoscopic and minilaparotomy approach as an operative management of ectopic pregnancy. Fifteen of 16 patients presenting to the Reproductive Endocrinology Service were managed using either operative laparoscopy or minilaparotomy. Serum hCG values at the time of diagnosis ranged from 239 to 8060 mIU/ml. Nine patients were managed by operative laparoscopy and six by minilaparotomy. All patients were ambulatory and tolerating oral intake within 8 hours of surgery. The average hospitalization was 31 hours from the time of surgery. Thirty-five percent of the patients were discharged within 24 hours and an additional 40% within 36 hours. This approach was applicable to all patients regardless of body habitus, degree of hemoperitoneum, or status of the ectopic pregnancy. Such a combined approach permitted minimal tissue manipulation and shortened hospitalization. Data of the present study suggest that such an approach may be applicable to most clinical circumstances, performed without undue morbidity and potentially avoid a standard laparotomy and its attendant risks and hospitalization.