Can Laparoscopic Management Of Ectopic Pregnancy Save Fallopian Tube?

Pregnancy in the abnormal place like Fallopian tube is defined as Tubal Ectopic Pregnancy.

Indication: 
Performed for pain in lower abdomen with H/o amenorrhea and Bleeding P/v and TVUSG showing tender adnexal mass or when medical treatment fails for ectopic.

Objective:
More than 90% cases of Ectopic pregnancy cases are now treated by Laparoscopy all over the world. Important pre-requisite for Laparoscopic management is – Patient should be haemodynamically stable. Ruptured Ectopic pregnancy should be treated by salpingectomy, as in subsequent pregnancy chances of repeat Ectopic will be more with Salpingostomy. Goal should be diagnosing Ectopic pregnancy in its asymptomatic -unruptured stage so that we can offer medical treatment with Methotraxate or Laparoscopic Salpingostomy or Tubal milking for preservation of affected tube. Recording the surgery helps another doctor for the decision of Salpingostomy/Salpingectomy during past surgery. Procedure takes hardly 30 minutes & patient can be discharged on the same day like Lap.T.L. 

Benefits of Laparoscopy Surgery:

1. Shorter Hospital stay.
2. Earlier return to your routine work.
3. Cosmetically vary small scar.
4. Less pain after operation.
5. Best fertility enhancement & Fertility results following Laparoscopy.
6. Video-live operative file available in CD/DVD for future reference (Transparency about surgical procedure).
7. The possibility of post-operative adhesion formation will be less, and the possibility of pain because of post-operative adhesions will also be less.  

Pre-operative Check Lists:

1. Lab. Investigation for Surgery (Urine complete & Blood complete, HbsAg, HIV, R.B.S.); Pelvic Trance vaginal USG report, UPT OR S.B-hCG
2. Operation planned before vital data deteriorates.
3. Preparation/shaving of local parts.

No. Of Cuts on Abdomen:
Three cuts: all of 5 mm size.

Average Stay in Hospital:
4 to 6 hours. (DAY CARE SURGERY)

Average Duration of Surgery:
20-30 minutes

Average Blood loss during Surgery:
Bloodless and 50 to 500 cc if ruptured Ectopic with free blood in the abdomen.

Average time after operation to resume normal activities/work:
Within 24 hours. Many patients undergo laparoscopy as Day care procedure, returning home within 24 hours of surgery. For normal ectopic laparoscopy procedure takes about 15 to 30 minutes only. For chronic ectopic it may take 1-2 hours. Most begin feeling much better within one day. 

Anesthesia:
General Anesthesia (Patient will not feel any pain in Operation Theatre during surgery) 

Operative Procedure:

Inside the Umbilicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside. 

Performing laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made inside the navel, and another two are usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen, which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.

Blood from the abdomen is suctioned with suction irrigation cannula. Affected Ectopic tube is desiccated with bipolar desiccation & cut & removed. For Salpingostomy anti-mesenteric border is cut after pitressin injection in mesosalpinx and ectopic sac delivered gently with suction & irrigation cannula. Haemostasis achieved by compression with atraumatic grasper. Copious irrigation is necessary to prevent post-operative adhesions.

Post-operative Course:

Patient remains drowsy/sedated for 4-5 hours after laparoscopy but conscious & pain free. Patient can take fluids 5-6 hours after laparoscopy & light food after 6-8 hours. She may feel little abdominal & shoulder pain after laparoscopy for 24 hours but it cam be relived with pain killer tabs. Most of the patients can walk normally without support and can take normal diet 6-8 hours after the laparoscopy. She can be discharged on the same day of the operation. Few patients may feel nausea & vomiting after laparoscopy, which can be very well controlled with injection in post-operative room. Patient can do her normal activity within 24 hours after laparoscopy. Patient is advised to take antibiotics & analgesic tabs. For 5 days following laparoscopy. Patient is advised to report to doctor for severe pain or bleeding or fever in postoperative period (Day-1 to Day-5) immediately. Patient is advised to come for follow up 7 days after the Laparoscopy for dressing.