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CO2 Laser Laparoscopic Salpingotomy for Treatment of Tubal Ectopic Pregnancies: Potential Limitations
Author(s) -
O'Shea Robert T.,
Thompson Graeme R. St J.
Publication year - 1990
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1990.tb02030.x
Subject(s) - methotrexate , medicine , ectopic pregnancy , trophoblast , laparoscopy , surgery , pregnancy , fetus , placenta , biology , genetics
EDITORIAL COMMENT: In appropriate selected cases (no shock, no active bleeding, no significant adhesions and no very high HCG levels) the treatment of choice of tubal ectopic pregnancy is by laparoscopic conservative surgery (salpingotomy). A laparoscopic approach compared to laparotomy, has proven economic advantages (shorter hospital stay and convalescence and earlier resumption of normal occupation) and suspected clinical advantages (less adhesion formation and better subsequent viable pregnancy rates) awaiting randomized prospective controlled studies for verification. Laparoscopic salpingectomy can also be performed with laser, as in this paper, or with cutting/coagulation diathermy (which is much, much cheaper) which yields comparative results. Salpingotomy can be performed laparoscopically with safety and could have been considered for one of the patients in this series who returned to theatre. The persistence of trophoblastic tissue requiring further treatment (usually methotrexate) occurs in about 10% of cases. Raphael Kuhn, Melbourne Summary: Linear salpingotomy was performed on 16 patients using the CO2 laser laparoscopically directed. Median operating time was 60 minutes (range 40–100) and all patients were discharged on the first postoperative day. There were 4 patients in whom persistence of trophoblast activity was detected, 2 of whom were treated surgically and 2 by oral methotrexate therapy.