Safety and efficacy of laparoscopic cornuotomy in the surgical management of complete interstitial ectopic pregnancy

Background: Laparoscopic cornuotomy is a relatively novel surgical approach to manage interstitial ectopic pregnancy (IEP) and there is little information regarding its safety and efficacy. Objectives: To describe the success, complications and long-term outcomes of women undergoing laparoscopic cornuotomy for IEP. Methods: Retrospective observational study carried out in a tertiary early pregnancy unit from June 2009 to April 2024. Main Outcome Measures: The main outcome measure was a complete resolution of the IEP without the need for any additional medical or surgical treatment. Results: There were 102 cases of complete IEP, of which 71 were managed surgically. The majority of operations were performed laparoscopically (70/71), including 62/70 who underwent a laparoscopic cornuotomy, and 8/70 who underwent an Endoloop-assisted salpingectomy. The remaining patient underwent a planned open procedure. A total of 60/62 [97%, 95% confidence interval (CI), 92-100] laparoscopic cornuotomies were successful, whilst the remaining two patients required further intervention for persistent trophoblast. The median total estimated blood loss for patients undergoing laparoscopic cornuotomy was 50 mLs (interquartile range: 50-150). There were 2/62 (3%, 95% CI, 0-8) intraoperative and 3/62 (5%, 95% CI, 0-10) postoperative complications. Twenty-seven patients (27/62, 44%) subsequently conceived, resulting in a total of 52 pregnancies. There were 25 pregnancies resulting in live birth, 13 of which were vaginal with no cases of uterine rupture. Conclusions: Laparoscopic cornuotomy is an effective treatment for complete IEP with only a small proportion of patients requiring interventions for retained pregnancy tissue. What is New?: This is the largest study of laparoscopic cornuotomy so far which showed that the procedure is effective with a low-risk of future pregnancy complications.