Temporary Simultaneous 2 Arterial Occlusions during Laparoscopic Management for Cornual Ectopic Pregnancy

Study Objective: To demonstrate a new technique of temporary simultaneous 2 arterial occlusions (TESTOs) of the uterine and ovarian (or utero-ovarian) artery to reduce operative blood loss during laparoscopic cornual resection for cornual ectopic pregnancy. Design: A step-by-step explanation of the surgical procedure using video (Canadian Task Force classification III). This study was approved by the institutional review board. Setting: A university hospital. Patients: A 41-year-old woman presented with pelvic pain with 7 weeks of amenorrhea. A transvaginal sonogram and laboratory tests revealed left cornual pregnancy. She had a history of left salpingectomy caused by tubal pregnancy and wanted prompt surgical management without a surgical scar. Interventions: During the single-port laparoscopy, we found a 3-cm unruptured ectopic mass in the left uterine cornua. The retroperitoneum was opened using a harmonic scalpel (Ethicon Endosurgery, Cincinnati, OH) along the infundibulopelvic ligament. Then, both uterine arteries were temporarily occluded with a bulldog clamp (Aesculap, Tuttlingen, Germany) at the level where they originate from the internal iliac artery. The bulldog clamp, which is a spring-loaded crossover clamp with serrated blades that effectively occlude vessels without slippage or significant crush injury, is the laparoscopic instrument for minimizing blood loss during the surgical procedure. Each ovarian arterial vasculature was also transiently occluded at the utero-ovarian or ovarian pedicle by placing a bulldog clamp. Then, a uterine incision was made in the left cornua using a harmonic scalpel, the gestational conception was expressed through the incision, and corneal resection was completed. The uterine defect was closed using a V-Loc suture (Covidien, Mansfield, MA). In the final step, all vascular clamps were removed for reperfusion. Measurements and Main Results: The operative time was 45 minutes. The procedure time for TESTO and the occlusion time (defined as the time that the bilateral uterine and ovarian vessels were occluded by bulldog clamps) were 10 and 12 minutes, respectively. The estimated blood loss was 50 mL, and her postoperative hemoglobin was 11.9 g/dL from 13.0 g/dL preoperatively. No complications occurred in the postoperative course. Her menstruation resumed 2 months after surgery. Conclusion: Surgical management of ectopic cornual pregnancy could be performed safely and efficiently under laparoscopy with the TESTO technique. © 2018 American Association of Gynecologic Laparoscopists