A GUIDE TO KEYHOLE SURGERY IN ECTOPIC PREGNANCY

This guide has been written for women who want to find out more about ectopic pregnancies and what happens should one occur. Whilst this guide offers general information about ectopic pregnancies and keyhole surgery, you should always see your GP or specialist if you are worried about ectopic pregnancy, have any further questions, or think that you might be at risk.

Introduction

An ectopic pregnancy is one that develops outside the womb, usually in the fallopian tube. There are two fallopian tubes that carry eggs from the ovaries to the womb. Normally the egg is fertilised and moved along the tube to the womb where the foetus can develop. But if the tube is damaged for any reason then the fertilised egg does not reach the womb and will implant itself in the tube and begin to grow. This will cause the tube to swell and, if allowed to continue, the tube will burst, and this can be fatal.

Causes and symptoms

A woman may have a damaged tube if she has ever had chlamydia or other pelvic inflammatory disease, or if she has had operations on her ovaries or tubes. A woman may also be at risk from an ectopic pregnancy if she has experienced difficulties in becoming pregnant or if she uses, or has used, an intrauterine device (IUD) or coil.

If a foetus starts to develop in the fallopian tube, you probably will not notice anything wrong with your pregnancy until you experience abdominal pain. There may also be some vaginal bleeding. Obviously this is not normal when you are pregnant, and you should see your doctor immediately. There is a simple blood test which can indicate an ectopic pregnancy. The doctor may also carry out an ultrasound scan which shows where the foetus is growing. It is estimated from recent data that around one in every seventy pregnancies is ectopic. Whilst some may miscarry naturally, medical treatment should be sought as early as possible.

Treatment

The only way to deal with an ectopic pregnancy is to have it removed. Unless the situation is caught in its most early stage, there is a high chance that the fallopian tube will have to be removed with the fertilised egg. If the tube is left, the chances of having another ectopic pregnancy are increased because of scarring from the operation. Although losing one fallopian tube does not make a women infertile, it will reduce the chances of her having a child.

The operation to remove the ectopic pregnancy will be carried out either by traditional open surgery or by keyhole surgery. With open surgery, the surgeon works directly on the fallopian tube through a single large incision in the abdomen.

Keyhole surgery involves one or more small incisions through which special surgical instruments are passed. The surgeon is able to see inside the body using an instrument called a laparoscope. A laparoscope is a form of telescope with a powerful light source. A miniature video camera is connected to the laparoscope and this projects a clear image onto a television screen. Viewing the operation on the monitor, the surgeon is able to manipulate the laparoscope and surgical instruments from outside the patient's body to carry out the surgical operation from within.

To create space around the organs and allow the surgeon a clear view, carbon dioxide gas is introduced into the abdomen. Two or three tiny incisions are then made through which the surgeon passes the laparoscope and special surgical instruments to perform the removal of the ectopic pregnancy.

Benefits

The benefits of laparoscopic (keyhole) removal of an ectopic pregnancy are:

• minimal scarring
• less pain
• less adhesions, which reduces the likelihood of further blockages
• shorter recovery time
• quicker return to normal activity

Occasionally, during an operation, the surgeon may discover an additional problem which complicates the procedure. In this situation, the surgeon will need to make a number of decisions, which might include converting from keyhole to open surgery. Ask your surgeon to explain the surgical procedure and any possible complications before your operation.