title: Laparoscopic management of ectopic pregnancies: a comparison between interstitial and "more distal" tubal pregnancies.
abstract: OBJECTIVE
  Laparoscopy is an established, safe, and feasible management option for tubal pregnancies, even in women with significant hemoperitoneum. In case of interstitial pregnancy, however, a laparoscopic surgical approach is still a matter of debate. The objective of this study is to evaluate the safety and feasibility of a laparoscopic approach to interstitial pregnancies.
  
  
  METHODS
  A total of 92 women with ectopic pregnancy who underwent a surgical management from April 2009 to August 2015 were reviewed. Clinical and surgical outcomes of confirmed interstitial pregnancies (n = 10) (IP group) were compared with those of "more distal" tubal pregnancies (n = 79) (TP group).
  
  
  RESULTS
  Although there were no differences between the two groups in gestational age, ß-hCG values were significantly higher in the IP group (p = 0.005). All patients with IP were treated by laparoscopic wedge resection. The rate of surgical complications (p = 0.413) and subsequent MTX treatment (p = 0.531) were not significantly different between groups. Operating room (OR) time (p = 0.007) was higher in the IP than in the TP group. After stratification for the presence of hemoperitoneum this difference remained, with patients in the IP group having longer OR time (p = 0.034) and additionally higher intra-operative blood loss (EBL) (p = 0.013). On the other hand, in the absence of hemoperitoneum no differences between the two groups were observed.
  
  
  CONCLUSIONS
  In experienced hands, the laparoscopic management of interstitial pregnancies seems to be as safe and feasible as that of other tubal pregnancies. However, it could be technically more challenging, especially in case of hemoperitoneum.
authors: Department of Obstetrics and Gynecology, Inselspital Bern, University of Berne, Effingerstrasse 102, 3010, Berne, Switzerland. kw.nirgianakis@gmail.com.
authors: Konstantinos
authors: K
authors: Nirgianakis
authors: Department of Obstetrics and Gynecology, Inselspital Bern, University of Berne, Effingerstrasse 102, 3010, Berne, Switzerland.
authors: Andrea
authors: A
authors: Papadia
authors: Department of Obstetrics and Gynecology, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico of Modena, 41124, Modena, Italy.
authors: Giovanni
authors: G
authors: Grandi
authors: Department of Obstetrics and Gynecology, Inselspital Bern, University of Berne, Effingerstrasse 102, 3010, Berne, Switzerland.
authors: Brett
authors: B
authors: McKinnon
authors: Department of Obstetrics and Gynecology, Inselspital Bern, University of Berne, Effingerstrasse 102, 3010, Berne, Switzerland.
authors: Daniele
authors: D
authors: Bolla
authors: Department of Obstetrics and Gynecology, Inselspital Bern, University of Berne, Effingerstrasse 102, 3010, Berne, Switzerland.
authors: Michael D
authors: MD
authors: Mueller
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000601:surgery*; D011274:Pregnancy, Tubal / Q000601:surgery*
keywords: Cornual pregnancy; Ectopic pregnancy; Extrauterine pregnancy; Interstitial pregnancy; Laparoscopy