TITLE:
Laparoscopic-assisted instillation of epinephrine and levobupivacaine enables cornual excision and anatomical reconstruction in unruptured cornual pregnancy
AUTHORS:
Juan Gilabert-Estelles, Juan Gilabert-Aguilar
KEYWORDS:
Cornual Pregnancy; Levobupivacaine; Epinephrine; Laparoscopy; Vasoconstrictive Agents
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.4 No.2,
February
11,
2014
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.