Laparoscopic Ectopic Pregnancy Surgery

Medically reviewed by Dr Manan Boob, MBBS (KEM), MS ObGyn (Gold Medalist), DNB — Consultant Gynaecologist & Laparoscopic Surgeon

What it is

An ectopic pregnancy is one that implants outside the womb, most often in a fallopian tube. A tube is not built to stretch the way the womb does, so as the pregnancy grows it can eventually burst and bleed inside the abdomen. Laparoscopic ectopic pregnancy surgery is keyhole surgery to deal with that pregnancy before this happens, or to stop the bleeding if it already has.

Depending on what we find, the operation is either a salpingectomy (removing the affected tube along with the pregnancy) or a salpingostomy (opening the tube, removing the pregnancy, and leaving the tube in place). Our broader advanced laparoscopy and hysteroscopy department performs these routinely, and you can see all the procedures we perform.

Who needs it

Many women come to us with a missed period, a positive pregnancy test, one-sided lower abdominal pain and some spotting or bleeding. The scan then shows no pregnancy in the womb, or a mass beside the ovary. Our guide on bleeding in early pregnancy explains why this pattern needs same-day attention.

Surgery is advised when:

• the pregnancy is causing severe pain or internal bleeding, or the tube has ruptured or is about to;
• you are unwell, faint or have low blood pressure;
• the hCG level is high or the pregnancy mass is large, so medicine is unlikely to work;
• a heartbeat is seen in the ectopic pregnancy;
• methotrexate has been tried and the hCG has not fallen, or follow-up is not practical.

If you have sudden severe pain, dizziness or fainting in early pregnancy, please go to a hospital straight away. Do not wait for a morning appointment.

“Can’t you just wait and see if it settles by itself?” Sometimes a very early ectopic pregnancy does resolve on its own, and we do watch carefully in selected women who are well and whose hCG is falling. But there is no way to be sure which ones will, and a rupture can happen fast. If the signs are not clearly reassuring, we do not wait.

How it is done

You are fasting and the anaesthetist puts you to sleep. If you have lost a lot of blood, resuscitation with fluids or blood comes first, and surgery is done at once.

A small cut is made near the navel, gas is gently put into the abdomen, and the telescope goes in. Two or three slim ports are added low in the abdomen.

First we look. We check the pregnancy and tube, the other tube and ovary, and the amount of blood in the pelvis. Blood is suctioned out and the pelvis is washed.

In salpingectomy, the affected tube is separated from its blood supply and removed, usually through one of the ports in a small bag. The ovary is left alone.

In salpingostomy, a small opening is made along the tube, the pregnancy tissue is gently lifted out, and the tube is left to heal without stitches. This is only suitable when the tube is not badly damaged and bleeding is under control. Because a little pregnancy tissue can be left behind, we do a follow-up hCG blood test afterwards until it falls to zero.

The removed tissue is sent for examination. The small cuts are closed.

Anaesthesia, duration and hospital stay

The operation is done under general anaesthesia.

It usually takes 45 minutes to an hour, and longer if there is a lot of blood to clear or the pelvis is full of adhesions.

Most women go home after one to two days. If you were very unwell when you came, you may need to stay longer.

Recovery

Day 1. Soreness at the cuts, a bloated feeling, and shoulder-tip pain from the gas, which is normal. You will be sipping water within a few hours, eating lightly soon after, and walking the same day. Many women also feel low or tearful; that is a natural reaction, and you may say so to us at any time.

The first week. Tiredness, mild pain that settles in a few days, and light vaginal spotting. Showers are fine from day three, with the dressings kept dry. If your blood group is Rh-negative, you will be given an anti-D injection.

Weeks 2 to 4. Desk work, driving and household tasks as you feel able. Avoid heavy lifting and strenuous exercise. We ask you to come for a follow-up visit, and for hCG tests if the tube was kept.

By six weeks. Back to normal routine. Your periods should return within a few weeks. Call us sooner for fever, spreading redness at a cut, worsening pain, heavy bleeding or fainting.

Why keyhole rather than open surgery

In a stable patient, keyhole is the better route, and it is what I advise. The cuts are small, pain is less, hospital stay is shorter, return to normal life is faster, and there is less scarring inside the pelvis, which matters for later fertility. The telescope also gives a clear look at both tubes and the pelvis.

If a woman arrives in shock with heavy internal bleeding, and the quickest safe option is to open the abdomen, I will do that without hesitation. Safety comes first, and I will explain this to the family.

Risks and complications

• Bleeding, during or after surgery, occasionally needing a blood transfusion.
• Persistent pregnancy tissue after salpingostomy. This is why hCG is checked until it reaches zero. A small number need a methotrexate injection or a repeat procedure.
• Injury to the bowel, bladder or blood vessels, uncommon, and a risk of any laparoscopy.
• Infection at a cut or within the pelvis.
• Another ectopic pregnancy in the future. The risk is higher after one has occurred, which is why early scans matter.
• Reduced fertility if the remaining tube is also damaged.
• Anaesthetic risks, which the anaesthetist will discuss with you separately.
• Conversion to open surgery, mostly if there is heavy bleeding or dense adhesions.

Alternatives

Methotrexate injection. Suitable for a small ectopic pregnancy in a stable woman, with a low hCG, no heartbeat, and no sign of rupture. It avoids an operation, but needs careful follow-up with repeat blood tests, and some women still end up needing surgery.

Watchful waiting. For selected women whose hCG is already falling and who have no symptoms, we can monitor with blood tests and scans. This requires reliable follow-up and quick access to hospital.

Open surgery, for a woman who is in shock or in whom keyhole is not safe.

Which option is right depends on your symptoms, your hCG, the scan and your wish to preserve fertility. We go through it with you, unhurried where time allows.

What it costs

The figure below is all-inclusive — surgeon’s fee, operation theatre, anaesthesia, room rent for a typical stay, medicines and routine investigations.

Laparoscopic ectopic pregnancy surgery (salpingectomy / salpingostomy): ₹40,000 – ₹60,000.

Please note: The figures above are indicative estimates for a typical case. The final cost depends on your individual condition, the complexity of the surgery, the room category you choose, how long you stay, and any complications that arise. Deluxe and super-deluxe rooms are charged higher. Emergency admissions and night or holiday surgery attract additional charges. These charges are subject to change without prior intimation. Please call us on +91-8668954915 for a written estimate for your own case before you decide anything.

Preparing for your surgery

Most ectopic surgery is planned in a hurry, so this is a short list.

• Bring your pregnancy test result, hCG report and scan reports if you have them.
• Tell us your blood group, and about any allergies, diabetes, thyroid problems or blood thinners.
• Please do not eat or drink anything from the time you suspect an ectopic pregnancy until we advise you.
• Bring an attendant, and keep your phone charged.
• Ask any question you have, including about future pregnancies. There is no such thing as a silly question here.
• If you are told to go home with methotrexate instead, make sure you know which symptoms mean you must return at once: sudden or severe pain, dizziness, or heavy bleeding.

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An ectopic pregnancy is frightening, and often a real loss. If you have missed a period and have one-sided pain or bleeding, please come in without delay. The gynaecology and laparoscopy team at Shubham Hi-Tech Hospital, Amravati, can scan you, explain what is happening, and treat you quickly and gently. Call +91-8668954915 or get in touch here.

Disclaimer: This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor for guidance specific to your situation.