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Comprehensive Video Atlas of Laparoscopic Surgery in Infertility and Gynecology
by Nutan JainThis video presents interesting case of a 32-years-old female married for 2 years she complaints the amenorrhea 2 months and severe pain in abdomen. Sonography: ectopic pregnancy—a heterogeneous mass seen very close to the uterus suggestive of chronic ectopic pregnancy. UPT positive, Beta-hCG-643 IU/L. Preoperative diagnosis: interstitial ectopic pregnancy. Port placement: patient laid in modified lithotomy position under GA. Four ports laparoscopy done, all the ports are 5 mm except camera port which is 10 mm. Surgical procedure: On inspection, the uterus had an asymmetrical swelling on the right side, bluish in color and tube was attached to its lateral end. It was highly suggestive of interstitial pregnancy. Dilute vasopressin injected at the junction of the uterus and interstitial ectopic gestational sac. The ectopic sac appeared blanched completely. A transverse incision given over the most bulging part of ectopic in full thickness by harmonic ACE. Ectopic gestational contents are not picked-up directly rather they are popped-out by the technique of hydrodissection, so that bleeding is minimized. Normal base of the sac found. No bleeding was noted. Opening in the interstitial pregnancy was sutured by deep bite of 1-0 vicryl. A good anatomical and functional outcome was achieved. HPE report confirmed ectopic gestational contents. Patient was advised for fertility after 6 months of the procedure and also advised to take early hospital visit in next pregnancy.
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