Surgical management of unruptured ectopic pregnancy

There is an increasing frequency of early diagnosis of unruptured tubal ectopic pregnancy. This is due primarily to better diagnostic testing, such as the use of ultrasound and radioimmunoassay for the beta-subunit of human chorionic gonadotropin. The more stable conditions of the patients at the time of surgery caused us to reconsider the need for laparotomy in these cases. Therefore, an attempt was made to definitively treat 18 patients with ectopic pregnancy utilizing laparoscopic techniques. Eighteen patients had signs, symptoms, and diagnostic test results suggestive of unruptured ectopic pregnancy. Laparoscopy was employed to confirm the diagnosis. If the tubal swelling was less than 3 cm in diameter, a linear salpingostomy was carried out on the antimesenteric side of the fallopian tube, utilizing a cutting current. The contents were expressed and removed through a second puncture site. Vigorous lavage was used to cleanse the abdomen, and bleeding was controlled with electrocautery. All tubes which were operated upon were patent at the time of postoperative hysterosalpingography. Fifty per cent of those patients actively trying to conceive have achieved pregnancy. There were not repeat ectopic pregnancies or abortions. There were no immediate or long-term postoperative complications. This method represents an alternative to the treatment of unruptured tubal ectopic pregnancies in early gestation.