Technique for Laparoscopic Management of Cornual Ectopic Pregnancy Using Vasopressin and Purse-string Suture
Year: 2026
Type: article
Study design: Case Report
Abstract: OBJECTIVE Cornual pregnancy (CP) is one of the rarest forms of ectopic pregnancy, accounting for 2.5% of all ectopic cases.[1] Compared to other forms of ectopic pregnancy, CP has a mortality rate that is seven times higher, due to delayed diagnosis and the potential for severe complications, such as cataclysmic hemoperitoneum.[1,2] Early asymptomatic cases can be managed medically using methotrexate. Surgical options include either cornuostomy or wedge resection. Cornuostomy involves a small incision over the bulging CP followed by excision using hydrodissection, with conservation of the ipsilateral Fallopian tube. Traditional wedge resection, on the other hand, is more radical and involves resection of the CP, surrounding myometrial mantle, and ipsilateral Fallopian tube. A modified technique of resection has been recently described where serosal incision is shifted distally, therefore minimizing myometrial damage without requiring CP manipulation.[3] Following the incision, dissecting through a cleavage plane between the myometrium and the gestational sac precludes bleeding and facilitates reconstruction.[4] Vasopressin injection with purse-string ectopic resection (VIPER) technique[5] has been described as very efficient for bleeding control and cornual reconstruction. In this video article, we illustrate laparoscopic cornual resection using the VIPER technique with a modified incision line.[3,5] DESIGN A step-by-step video demonstration of a surgical technique [Video 1]. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 1.","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_ygjpbfay"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} PATIENT The case was that of an 8-week 5-day pregnant woman presenting with suboptimally rising human chorionic gonadotropin and a right viable CP on ultrasound. Urgent surgical treatment was recommended. INTERVENTIONS During laparoscopy, the following steps were performed: Twenty milliliters of diluted Argipressin (20 units in saline 100 mL) is infiltrated circumferentially into the myometrium at the CP base A circumferential 2-0 V-Loc suture is placed around the CP base A circumferential incision is then performed 2 cm distally to the purse-string suture [Figure 1] The CP is resected by cutting bit by bit through the marginal zone between the sac and the normal myometrium. A regular anterograde salpingectomy is then performed The purse-string suture is used to close the defect in two layers with good approximation. Figure 1: Incision line around the cornual pregnancy giving access to the cleavage planehttp://www.apagemit.com/page/video/show.aspx?num= 1389&kind=2&page=1CONCLUSION The purse-string suture has several benefits during cornual resection: it allows stabilization of the CP bulge, serves as a tourniquet, and facilitates myometrial repair thereafter. In our case, it was not used as a tourniquet since no bleeding was noted during resection due to the Argipressin-induced vasoconstriction. However, the suture can be tightened in case bleeding is encountered at any point. Cornual resection is a radical procedure and is more destructive to the myometrium when compared to cornuostomy. It reduces the risk of retained tissue and recurrence since the whole Fallopian tube, including its interstitial segment, is resected.[1] Using the modified incision and dividing through the marginal zone without manipulating the trophoblastic tissue allows intact enucleation of the CP while causing minimal damage to the surrounding myometrium.[3] This technique does not seem to affect fertility rates or neonatal outcomes[6] but might increase the risk of uterine rupture.[7] Cornuostomy, on the other hand, conserves uterine architecture and therefore might have lower risks of uterine rupture.[1] The choice of the technique depends on previous obstetric history, contralateral tubal patency, and patient’s preferences following counseling. Ethics statement This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and its amendments. The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Author contributions WA: Video editing and narration, review and analysis of the literature, manuscript drafting and editing. SG: Paper conception, critical review and editing of the manuscript.Both authors approved the final version of the manuscript. Data availability statement Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study. Financial support and sponsorship Nil. Conflicts of interest The authors have no conflicts of interest to disclose.
Authors: Wissam Arab, Sujata Gupta
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7123665179