Laparoscopy.com

Laparoscopy.com presents a laparoscopic left salpingectomy after attempted salpingostomy for a left tubal ectopic pregnancy in a 32-year-old gravida 3 para 2. She presented with the classic triad of pelvic pain, uterine bleeding, and an adnexal mass. The patient lacked risk factors for an ectopic pregnancy such as a history of PID, operative trauma, or tumors. Because she wished to retain her fertility, a salpingostomy was initially attempted to save the tube, but hemorrhage and retained trophoblastic tissue dictated a partial salpingectomy, removal of part of the tube.

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The ectopic pregnacy is visualized in the ampullary region of the left fallopian tube.

Gastric Bypass enterotomy

Salpingostomy on the antimesenteric border is perfomed to allow withdraw of the products of conception and preservation of the tube.

gastric bypass division of the mesentery

After the tube is opened, a grasper is used to remove the products of conception.

gastric bypass entero enterotomy

Unfortunately, bleeding occurs after removal of the products of conception, but electrocoagulation is used to achieve hemostasis.

gastric bypass entero enterostomy closure

Electrocoagulation has achieved hemostasis, but the tube must be partially removed due to the retained trophoblastic tissue. The tissue remains because of possible location within the muscularis or serosa.

gastric bypass rent closure

Successive electocoagulation of the mesosalpinx and subsequent sharp dissection allows partial salpingectomy.

gastric bypass entero enterostomy closure

The distal tube has been removed through the port.

gastric bypass rent closure

Once hemostasis is assured, the hemoperitoneum is evacuated. A single follow-up ß-HCG should be drawn 2-3 weeks post op.