Microsurgical technique in the management of tubal ectopic pregnancy

Microsurgical techniques employing fine instruments and suture, microelectrocautery and continuous lavage, and careful handling of tissue have been applied to a variety of gynecologic procedures in which the microscope itself is not warranted. The thesis underlying this practice is straightforward: if successful outcome in chronic tubal disease is enhanced by these procedures, then they may have a beneficial role in acute tubal disease. To test this premise, in the past 2 years nine patients with tubal ectopic pregnancies have been managed by microsurgical techniques at Yale-New Haven Hospital. Five of the ectopic pregnancies were unruptured and four were ruptured. The products of conception were removed either by meticulous debridement or linear antimesenteric salpingostomy in association with the microsurgical methods noted above. Tubal healing was by secondary intention. All patients were treated with prophylactic antibiotics and intra-abdominal low molecular weight dextran. Four months postoperatively, all tubes operated upon were patent by salpingography. Subsequently, three of the five women with unruptured pregnancies and two of the four with ruptured pregnancies achieved intrauterine pregnancies. However, one has spontaneously aborted. According to these preliminary results, microsurgical techniques may be beneficially applied in the treatment of selected cases of ectopic pregnancy.