Share This Article:

Laparoscopic-assisted instillation of epinephrine and levobupivacaine enables cornual excision and anatomical reconstruction in unruptured cornual pregnancy

Abstract Full-Text HTML XML Download Download as PDF (Size:101KB) PP. 66-70
DOI: 10.4236/ojog.2014.42012    4,476 Downloads   5,485 Views  

ABSTRACT

The objective of this report is to describe the possible use of intramiometrial vasoconstrictive agents for laparoscopic management of interstitial pregnancy and the consequences in anatomical results and reproductive outcomes. Cornual resection can be performed by laparoscopy, but the high vascularization of this area may result in profuse bleeding and laparoscopic suturing under these conditions might be impossible for the majority of the surgeons. We present a case that describes the possible use of intramiometrial instillation of a solution of diluted epinephrine and levobupivacaine under laparoscopic guidance that permitted a bloodless cornual excision with complete reconstruction. Vasoactive agents might have potentially serious cardiovascular side effects and the correct election of the active principle and the dosage is essential to reduce the risk of the surgery and obtain good anatomical results and reproductive outcomes. In conclusion, unruptured interstitial pregnancies can be managed successfully with intramyometrial instillation of epinephrine and bupivacaine. This simple technique is particularly attractive as it facilitates anatomical reconstruction of the cornual area, gives enough time to perform a complete suture of the defect and reduces the risk of laparotomic conversion.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Gilabert-Estelles, J. and Gilabert-Aguilar, J. (2014) Laparoscopic-assisted instillation of epinephrine and levobupivacaine enables cornual excision and anatomical reconstruction in unruptured cornual pregnancy. Open Journal of Obstetrics and Gynecology, 4, 66-70. doi: 10.4236/ojog.2014.42012.

References

[1] Tulandi, T. and Al-Jaroudi, D. (2004) Interstitial pregnancy: Results generated from the Society of Reproductive Surgeons Registry. ACOG, 103, 47-50.
[2] Reich, H., McGlynn, F., Budin, R., Tsoutsoplides, G. and DeCaprio, J. (1990) Laparoscopic treatment of ruptured interstitial pregnancy. Journal of Gynecologic Surgery, 6, 135-138. http://dx.doi.org/10. 1089/gyn.1990.6.135
[3] Tinelli, A., Malvasi, A., Pellegrino, M., Pontrelli, G., Martulli, B. and Tsin, D.A. (2010) Laparoscopical management of cornual pregnancies: A report of three cases. European Journal of Obstetrics & Gynecology and Reproductive Biology, 151, 199-202. http://dx.doi.org/10.1016/j.ejogrb.2010.03.032
[4] Morita, Y., Tsutsumi, O., Momoeda, M. and Taketani, Y. (1997) Cornual pregnancy successfully treated laparoscopically with fibrin glue hemostasis. Obstetrics & Gynecology, 90, 685-687.
http://dx.doi.org/10. 1016/S0029-7844(97)00398-0
[5] Dalkalitsis, N., Stefanidis, K., Paschopoulos, M., Navrozoglou, I., Mouzakioti, E. and Lolis, D. (1998) Laparoscopic treatment of interstitial pregnancy using the harmonic scalpel. Clinical & Experimental Obstetrics & Gynecology, 25, 49-50.
[6] Choi, Y.S., Eun, D.S., Choi, J., Shin, K.S., Choi, J.H. and Park, H.D. (2009) Laparoscopic cornuotomy using a temporary tourniquet suture and diluted vasopressin injection in interstitial pregnancy. Fertility and Sterility, 91, 1933-1937. http://dx.doi.org/10.1016/j.fertnstert.2008.02.013
[7] Raheem, M. and Yousri Afifi, Y. (2008) Laparoscopic selective ipsilateral uterine artery ligation for the management of a cornual ectopic pregnancy. Journal of Minimally Invasive Gynecology, 15, 260-261. http://dx.doi.org/10.1016/j.jmig.2008.02.008
[8] Katz, D.L., Barrett, J.P., Sanfilippo, J.S. and Badway, D.M. (2003) Combined hysteroscopy and laparoscopy in the treatment of interstitial pregnancy. American Journal of Obstetrics & Gynecology, 188, 1113-1114. http://dx.doi.org/10.1067/mob.2003.258
[9] Ostrzenski, A. (1997) A new laparoscopic technique for interstitial pregnancy resection. A case report. The Journal of Reproductive Medicine, 42, 363-366.
[10] Sergent, F., Le Cornec, J.B., Meilhaud, M.F. and Marpeau, L. (2003) Laparoscopic cornual excision with an automatic stapler for ruptured interstitial pregnancies. Journal de Gynecologie, Obstetrique et Biologie de la Reproduction’s, 32, 426-430.
[11] Moon, H.S., Choi, Y.J., Park, Y.H. and Kim, S.G. (2000) New simple endoscopic operations for interstitial pregnancies. American Journal of Obstetrics & Gynecology, 182, 114-121.
http://dx.doi.org/10.1016/S0002-9378(00)70499-6
[12] Schulz, K.F., Grimes, D.A. and Christensen, D.D. (1985) Vasopressin reduces blood loss from second-trimester dilatation and evacuation abortion. Lancet, 2, 353-356. http://dx.doi.org/10.1016/S0140-6736(85)92496-1
[13] Fletcher, H., Frederick, J., Hardie, M. and Simeon, D. (1996) A randomized comparison of vasopressin and tourniquet as hemostatic agents during myomectomy. Obstetrics & Gynecology, 87, 1014-1018. http://dx.doi.org/10.1016/0029-7844(96)00071-3
[14] Phillips, D.R., Nathanson, H.G., Milim, S.J., Haselkorn, J.S., Khapra, A. and Ross, P.L. (1996) The effect of dilute vasopressin solution on blood loss during operative hysteroscopy: A randomized controlled trial. Obstetrics & Gynecology, 88, 761-766. http://dx.doi.org/10.1016/0029-7844(96)00282-7
[15] Okin, C.R., Guido, R.S., Meyn, L.A. and Ramanathan, S. (2001) Vasopressin during abdominal hysterectomy: A randomized controlled trial. Obstetrics & Gynecology, 97, 867-872.
http://dx.doi.org/10.1016/S0029-7844(01)01353-9
[16] Nezhat, F., Admon, D., Nezhat, C.H., Dicorpo, J.E. and Nezhat, C. (1994) Life-threatening hypotension after vasopressin injection during operative laparoscopy, followed by uneventful repeat laparoscopy. Journal of the American Association of Gynecologic Laparoscopists, 2, 83-86.
http://dx.doi.org/10.1016/S1074-3804(05)80837-0
[17] Tulandi, T., Beique, F. and Kimia, M. (1996) Pulmonary edema: A complication of local injection of vasopressin at laparoscopy. Fertility and Sterility, 66, 478-480.
[18] Lurie, S. and Mamet, Y. (2000) Transient myocardial ischemia may occur following subendometrial vasopressin infiltration. European Journal of Obstetrics & Gynecology and Reproductive Biology, 91, 87-89. http://dx.doi.org/10.1016/S0301-2115(99)00233-X
[19] Rutsuko, H., Sachiko, N., Yasuki, K. and Osamu, T. (2009) Bradycardia and Cardiac Arrest Caused by Intramyometrial Injection of Vasopressin during a Laparoscopically Assisted Myomectomy. Obstetrics & Gynecology, 113, 484-486.
[20] Zullo, F., Palomba, S., Corea, D., Pellicano, M., Russo, T., Falbo, A., Barletta, E., Saraco, P., Doldo, P. and Zupi, E. (2004) Bupivacaine plus epinephrine for laparoscopic myomectomy: A randomized placebo-controlled trial. Obstetrics & Gynecology, 104, 243-249. http://dx.doi.org/10.1097/01.AOG. 0000132801.41880.e8
[21] Kongnyuya, E.J., van den Broeka, N. and Wiysongeb, C.S. (2008) A systematic review of randomized controlled trials to reduce hemorrhage during myomectomy for uterine fibroids. Obstetrics & Gynecology, 100, 4-9.
[22] McClellan, K.J. and Spencer, C.M. (1998) Levobupivacaine. Drugs, 56, 355-362.
http://dx.doi.org/10.2165/00003495-199856030-00005
[23] England, G.T., Randall, H.W. and Graves, W.L. (1983) Impairment of tissue defenses by vasoconstrictors in vaginal hysterectomies. Obstetrics & Gynecology, 61, 271274.
[24] Newton, D.J., McLeod, G.A., Khan, F. and Belch, J.J. (2005) Vasoactive characteristics of bupivacaine and levobupivacaine with and without adjuvant epinephrine in peripheral human skin. British Journal of Anaesthesia, 94, 662-667. http://dx.doi.org/10.1093/bja/aei095
[25] Foster, R.H. and Markham, A. (2000) Levobupivacaine: A review of its pharmacology and use as a local anaesthetic. Drug, 59, 551-579. http://dx.doi.org/10.2165/00003495-200059030-00013
[26] Louizos, A.A., Hadzilia, S.J., Leandros, E., Kouroukli, I.K., Georgiou, L.G. and Bramis, J.P. (2005) Postoperative pain relief after laparoscopic cholecystectomy: A placebo-controlled double-blind randomized trial of preincisional infiltration and intraperitoneal instillation of levobupivacaine 0.25%. Surgical Endoscopy, 19, 1503-1506. http://dx.doi.org/10.1007/s00464-005-3002-4
[27] Alessandri, F., Lijoi, D., Mistrangelo, E., Nicoletti, A. and Ragni, N. (2006) Effect of presurgical local infiltration of levobupivacaine in the surgical field on postsurgical wound pain in laparoscopic gynecological surgery. Acta Obstetricia et Gynecologica Scandinavica, 85, 844-849.
http://dx.doi.org/10.1080/00016340500494846
[28] Benifla, J.L., Fernandez, H., Sebban, E., Darai, E., Frydman, R. and Madelenat, P. (1996) Alternative to surgery of treatment of unruptured interstitial pregnancy: 15 cases of medical treatment. European Journal of Obstetrics & Gynecology and Reproductive Biology, 70, 151-156.
http://dx.doi.org/10.1016/S0301-2115(95)02589-8
[29] Lalchandani, S., Geary, M., O’Herlihy, C. and Sheil, O. (2003) Conservative management of placenta accreta and unruptured interstitial cornual pregnancy using methotrexate. European Journal of Obstetrics & Gynecology and Reproductive Biology, 107, 96-97. http://dx.doi.org/10.1016/S0301-2115(02)00241-5
[30] Fisch, J.D., Ortiz, B.H., Tazuke, S.L., Chitkara, U. and Giudice, L.C. (1998) Medical management of interstitial ectopic pregnancy: A case report and literature review. Human Reproduction, 7, 1981-1986. http://dx.doi.org/10.1093/humrep/13.7.1981
[31] Lau, S. and Tulandi, T. (1999) Conservative medical and surgical management of interstitial ectopic pregnancy. Fertility and Sterility, 72, 207-215. http://dx.doi.org/10.1016/S0015-0282(99)00242-3
[32] Ross, R., Lindheim, S.R., Olive, D.L. and Pritts, E.A. (2006) Cornual gestation: A systematic literature review and two case reports of a novel treatment regimen. JMIG, 13, 74-78.

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.