Operative laparoscopy for ectopic pregnancy: how experienced should the surgeon be?

The purpose of this study was to assess the efficacy of laparoscopic surgery for ectopic pregnancy in a general hospital in Paris, where most of the surgeons are still in training. During a period of 20 months, 100 cases of ectopic pregnancy were diagnosed and treated by the attending residents. Nine cases required a laparotomy due to heavy bleeding or interstitial ectopic pregnancy. Most of the other cases were treated laparoscopically, with either salpingectomy (70 cases) or linear salpingostomy (19 cases). Complications of the laparoscopic surgical procedures were rare. There was one failure of linear salpingostomy that required a second intervention (5.3% failure rate); there was one case of urinary retention that resolved after 48 h; and one case of fever above 38 degrees C that responded well to antimicrobial therapy. In conclusion, we have shown that the current notion that laparoscopic surgery is preferred to conventional abdominal surgery for the treatment of ectopic pregnancy, can be applied to a public gynaecological centre with young inexperienced residents, supervised by experienced gynaecologists.