Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy (Drs. Mangino, Romano, Di Lorenzo, Buonomo, De Santo, Scrimin, and Ricci).
Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy (Drs. Mangino, Romano, Di Lorenzo, Buonomo, De Santo, Scrimin, and Ricci).
J Minim Invasive Gynecol. 2019 Sep-Oct;26(6):1011-1012. doi: 10.1016/j.jmig.2019.01.009. Epub 2019 Jan 26.
To evaluate the efficacy of total surgical treatment of ectopic cervical pregnancy [1] with a minimally invasive approach performed by hysteroscopy [2].
Step-by-step video demonstration of the surgical technique using 5 mm hysteroscopy followed by 10 mm resectoscopy.
A research and university hospital (IRCCS Burlo Garofolo, Trieste, Italy).
A 41-year-old woman with an ultrasound diagnosis of ectopic cervical pregnancy at 6 + 6 weeks of gestation with a beta human chorionic gonadotropin serum level of 55.951 mUI/mL.
We performed a 2-step technique using 5- and 10-mm hysteroscopy (Video 1). During the first step, a 5-mm Bettocchi hysteroscope (Karl Storz, Tuttlingen, Germany) with a 5F bipolar electrode Versapoint Twizzle (Gynecare, Menlo Park, CA) was used. In this phase, the gestational sac was identified in order to confirm the diagnosis and its site of implantation. Later, the gestational sac was opened, and the pregnancy was terminated by cord section under an embryoscopic view (Fig. 1). Finally, a partial vessel coagulation was performed. Afterward, the cervix was dilated, and a resectoscopy was performed. During the second step, a 10-mm Gynecare resectoscope with the bipolar Gynecare Versapoint was used and the gestational sac with the embryo was removed; subsequently, a complete chorial villi resection was achieved. At last, a coagulation of bleeding vessels on the implantation site in order to control the hemostasis was performed (Fig. 2).
The study was approved by the institutional review board. The patient was discharged 24 hours after the procedure with an uneventful postoperative course, and the beta human chorionic gonadotropin serum level became negative in 20 days. After 40 days, the ultrasound cervical findings were regular, whereas office hysteroscopy showed the implantation site scar. After 5 months, the patient was pregnant with regular intrauterine implantation (Fig. 3).
The total hysteroscopic approach with a 2-step technique offers an effective, safe, and minimally invasive surgical treatment to ectopic cervical pregnancy. Considering that our method, in contrast with the recent literature [3-5], is performed without any medical treatment, we reported for the first time an approach, that deserve more clinical data to confirm its effectiveness.
评估经阴道镜[2]微创入路行全子宫颈妊娠[1]切除术的疗效。
使用 5mm 宫腔镜，然后使用 10mm 电切镜逐步演示手术技术。
研究和大学医院（意大利里雅斯特的 IRCCS Burlo Garofolo）。
一位 41 岁的女性，超声诊断为妊娠 6+6 周的宫颈妊娠，β人绒毛膜促性腺激素血清水平为 55.951 mIU/mL。
我们采用两步法，使用 5-10mm 宫腔镜（视频 1）。第一步使用 5mm Bettocchi 宫腔镜（德国图特林根的 Karl Storz）和 5F 双极电极 Versapoint Twizzle（Gynecare，加利福尼亚州门洛帕克）。在此阶段，识别妊娠囊以确认诊断及其着床部位。随后，切开妊娠囊，在胚胎镜下切断脐带以终止妊娠（图 1）。最后，进行部分血管凝固。之后，扩张宫颈，进行电切镜检查。第二步使用 10mm Gynecare 电切镜和双极 Gynecare Versapoint 切除妊娠囊和胚胎，随后完全切除绒毛组织。最后，在着床部位进行止血血管凝固以控制止血（图 2）。
该研究得到了机构审查委员会的批准。患者在手术后 24 小时出院，术后恢复顺利，β人绒毛膜促性腺激素血清水平在 20 天内转为阴性。40 天后，超声宫颈检查正常，门诊宫腔镜检查显示着床部位有疤痕。5 个月后，患者再次怀孕，宫内妊娠正常（图 3）。
两步法全宫腔镜方法为宫颈妊娠提供了一种有效、安全和微创的手术治疗方法。与最近的文献[3-5]相比，我们的方法无需任何药物治疗，因此我们首次报道了一种方法，值得更多的临床数据来证实其有效性。
