This video titled "Laparoscopic Management of Chronic Ectopic Pregnancy: A Safe and Fertility-Preserving Approach" presents a comprehensive surgical overview of how laparoscopy serves as the gold-standard method for managing chronic ectopic pregnancy—a rare and often challenging gynecologic condition. Filmed at World Laparoscopy Hospital, under the expertise of Prof. Dr. R. K. Mishra, the procedure demonstrates the precision, safety, and fertility-conscious approach taken in such complex cases.

What is Chronic Ectopic Pregnancy?

Unlike acute ectopic pregnancy, which presents with sudden pain and hemodynamic instability, chronic ectopic pregnancy develops insidiously over weeks. It often leads to persistent pelvic pain, irregular bleeding, and the formation of a hematocele or adnexal mass, due to recurrent minor tubal bleeding. It is frequently misdiagnosed as pelvic inflammatory disease or ovarian cyst due to low or declining β-hCG levels and non-specific imaging findings.

Surgical Highlights from the Video

Diagnostic laparoscopy to confirm presence of ectopic mass and rule out pelvic adhesions
Careful dissection and adhesiolysis in cases with surrounding inflammation and fibrosis
Salpingostomy for fertility preservation when the tube is salvageable
Salpingectomy when the tube is ruptured, fibrosed, or non-functional
Meticulous hemostasis using bipolar energy or harmonic scalpel
Thorough irrigation and suctioning of hemoperitoneum and necrotic debris

The video offers detailed operative footage along with commentary on decision-making, energy device selection, and techniques to minimize tubal trauma and preserve ovarian function.

Advantages of Laparoscopic Management

Minimally invasive with small incisions and faster recovery
Reduced postoperative pain and hospital stay
Enhanced visualization for complete removal of ectopic tissue
Fertility-sparing options available based on intraoperative findings
Lower complication and adhesion rates compared to open surgery

When to Suspect Chronic Ectopic Pregnancy?

This condition should be considered when a woman of reproductive age presents with:

Persistent pelvic pain and abnormal bleeding
A pelvic mass on ultrasound, particularly in the adnexal region
Negative or low β-hCG levels, especially with no intrauterine pregnancy on scan
History of tubal damage, previous ectopic pregnancy, or pelvic infection

Conclusion

The laparoscopic management of chronic ectopic pregnancy is a safe, effective, and fertility-conscious approach that demands surgical expertise and sound clinical judgment. This video from World Laparoscopy Hospital not only showcases the technique but also serves as a vital educational resource for gynecologic surgeons dealing with atypical ectopic cases. With meticulous dissection, hemostasis, and anatomical preservation, laparoscopy offers superior outcomes in terms of both recovery and reproductive potential.

Watch the full video to understand the nuances of laparoscopic management, from diagnosis to successful resolution of this complex condition.
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