title: Laparoscopic hysterotomy for a failed termination of pregnancy: a first case report with demonstration of a new surgical technique.
abstract: OBJECTIVE
  To show a new technique of hysterotomy via laparoscopy for a failed termination of pregnancy as an alternative for a hysterotomy via laparotomy.
  
  
  METHODS
  Step-by-step explanation of the technique using parts of the original video of the procedure (Canadian Task Force classification III).
  
  
  METHODS
  A 39-year-old woman, para 1 gravida 2, was diagnosed with a trisomy 21 pregnancy at 18 weeks' gestation. After 7 days of failed medical and mechanical induction, including misoprostol per vaginam, intravenous sulprostone , intravenous oxytocin, a transcervical Foley catheter, and a transcervical Bakri balloon (Cooke Medical, Bloomington, IN), the decision was made to perform a laparoscopic hysterotomy.
  
  
  METHODS
  A laparoscopic hysterotomy was performed with extraction of the fetus and placenta in an endobag. The uterus was sutured using a double layer of 2 continuous Vicryl 1 sutures (Ethicon, Cincinnati, OH). The umbilical incision was enlarged to 2.5 cm to extract the endobags. The procedure was performed using only standard reusable laparoscopic equipment.
  
  
  RESULTS
  The patient's postoperative recovery was uneventful. On the postoperative ultrasound, we suspected that a small piece of placental tissue had been left in the uterine cavity. A hysteroscopy confirmed this and showed a normal uterine cavity. The small placental fragment regressed spontaneously on the follow-up ultrasounds. A 2-year follow-up of the patient has shown no minor or major complications. The patient has used contraception since the procedure because she has no further desire for childbearing.
  
  
  CONCLUSIONS
  This new technique can help surgeons avoid a laparotomy when a hysterotomy for a failed midtrimester termination of pregnancy is required. The risk of uterine rupture in a next pregnancy needs to be taken into account. This frugally innovative technique may potentially be performed in a low-resource setting because only standard reusable laparoscopic equipment was used.
authors.affiliation: Department of Obstetrics and Gynaecology, AZ Imelda Hospital, Bonheiden, Belgium. Electronic address: jan.baekelandt@imelda.be.
authors.forename: Jan
authors.initials: J
authors.lastname: Baekelandt
authors.affiliation: Department of Obstetrics and Gynaecology, AZ Imelda Hospital, Bonheiden, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Bosteels
mesh_terms: D000028:Abortion, Induced; D000328:Adult; D015232:Dinoprostone / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D020883:Hysterotomy / Q000379:methods*; D010535:Laparoscopy; D007813:Laparotomy / Q000379:methods; D010121:Oxytocin; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D016896:Treatment Outcome
chemical_list: D010121:Oxytocin; C016767:sulprostone; D015232:Dinoprostone
keywords: Frugal innovation; Hysterotomy; Laparoscopy; Midtrimester abortion