Laparoscopic management of invasive retained products of conception: a case series

BACKGROUND: Prostaglandins and other uterotonics are first-line medical management for retained products of conception (RPOC), with transcervical surgery reserved for failed conservative management. In the rare setting of invasive retained products of conception (iRPOC), however, these approaches may not achieve complete evacuation. This study assessed laparoscopic resection as a fertility-preserving treatment for iRPOC. METHODS: This case series included all eligible patients who underwent laparoscopic resection for iRPOC at a single tertiary centre between January 2012 and June 2024. Effectiveness was defined as complete resection on intra-operative transvaginal ultrasound scan (TVUS), no requirement for re-intervention, and no evidence of residual RPOC on follow-up TVUS 4-6 weeks post-operatively. Safety and post-operative fertility were evaluated as secondary outcomes. RESULTS: Sixteen patients with iRPOC were included, with a mean age of 34.9 years and a mean follow-up of 61 months. Eight cases followed miscarriage or termination of pregnancy, and eight followed birth. Ultrasound-guided laparoscopic resection with uterine reconstruction was successful in all cases. Mean operative time, blood loss, and hospital stay were 69.6 min, 271.9 mL, and 1.9 days, respectively. Three patients attempting pregnancy subsequently conceived uneventfully. CONCLUSIONS: Laparoscopic management of iRCOP seems to be a feasible, effective and safe management option.