Table I.
Complete summary of the included studies and their findings (1/2).
| Study ID | Study design | Sites and time | Participants and main inclusion criteria | Total cases n | Type of Laparoscopic surgery, (n) | Type of Traditional surgery, (n) | Investigations | Results | Conclusion of the study |
|---|---|---|---|---|---|---|---|---|---|
| Jiang 2018 (32) | Retrospective analysis | Nanjing Drum Tower Hospital, China. Records from July 2010 to December 2015 | Patients with intrauterine pregnancy along with feature of a co-existing interstitial pregnancy: A gestational sac visualized high in the fundus. not surrounded by 5 mm of myometrium in all planes.a gestational sac seen separately and < 1 cm from the most lateral edge of the uterine cavity. | 17 | Laparoscopic cornual resection, (7) | Laparotomy with cornual resection, (3) | Transvaginal ultrasound scan | Compared with laparotomy, laparoscopic cornual section showed shorter operative time (median 40 vs. 70 min), less blood loss (150 vs. 400 ml) and shorter hospital stay (2 vs. 4 days). | Laparoscopic cornual resection is a feasible approach with favorable surgical and long-term pregnancy outcomes. |
| Hwang 2010 (26) | Retrospective analysis | The Korea University Medical Center, South Korea. Records from January 1998 to October 2009 | Patients with interstitial pregnancy who were treated with open cornual resection or laparoscopic cornual resection. | 88 | Laparoscopic cornual resection, (34) | Open cornual resection, (54) | Transvaginal ultrasound scan | There were no statistically significant differences between the two groups for the mean operation time, estimated blood loss, blood loss of more than 1000 mL, blood transfusion requirements, and complications. The mean number of postoperative hospital days was shorter in the laparoscopy group than in the laparotomy group (4.53 ± 1.44 days versus 5.89 ± 1.86 days, respectively; P < 0.001). | Laparoscopic cornual resection is a safe and less invasive procedure with a reasonable complication rate and shorter hospital stay. |
| Ghazali 2018 (27) | Retrospective cohort | Putrajaya Hospital, Putrajaya, Malaysia. Records from January 2005 to December 2014, | Patients with interstitial pregnancy who were treated with open cornual resection or laparoscopic cornual resection. | 14 | Laparoscopic cornuotomy, (7) | Open cornuotomy, (7) | Physical examination, transvaginal sonography, full blood count, and serum human chorionic gonadotrophin (hCG) levels. | The duration of hospitalization and mean operating time were both significantly shorter in the LC group than in the OC group (1.43 ± 0.54 versus 2.57 ± 0.79 and 61.4 ± 15.7 min versus 97.1 ± 38.2 min, respectively, P < 0.05).There were no statistically significant differences between both groups for the estimated blood loss, requirement of blood transfusion, complications, and future fertility. | Laparoscopic cornual resection (cornuotomy) is a safe and less invasive procedure with a comparable complication rate. It has shown that it is feasibility and should be considered as initial treatment in managing those cases in trained hand surgeons. |
| Sagiv 2013 (22) | Retrospective cohort | Wolfson Medical Center, Holon, and 2Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Records from June 1997 to June 2007. | Patients with interstitial pregnancy who were treated with laparotomy, medical treatment with systemic methotrexate, or laparoscopy. | 14 | Laparoscopy cornuostomy, encircling, or salpingectomy, (8) | Laparotomy, (5) | Transvaginal ultrasound scan | The first four women, with significant hemoperitoneum, were treated by laparotomy. Of the next 10 women, four were selected for medical treatment with methotrexate. Only one case was treated successfully. The other six women had laparoscopic treatment. Of nine laparoscopies, one was converted to laparotomy due to excessive blood loss during the procedure. Of nine women desiring a child, three were infertile, whereas six conceived with an intrauterine pregnancy. | A change from diagnosis later in pregnancy and laparotomy to more conservative treatment, mainly by laparoscopy, suggests a possibly better subsequent pregnancy rate. |
| Tulandi 2004 (23) | Cross sectional | Cases from 1999 to 2002. | Patients with interstitial pregnancy who were treated with laparotomy, methotrexate, or laparoscopy. | 32 | Laparoscopy, (11) | Laparotomy, (13) | Transvaginal ultrasound scan and diagnostic laparoscopy and laparotomy. | Persistently elevated serum human chorionic gonadotropin levels were found in one patient after laparoscopic cornual excision, and she was successfully treated with methotrexate. Fourteen cases (43.7%) of rupture of interstitial pregnancy were found. This included five cases (15.6%) of heterotopic pregnancy; all were the results of in vitro fertilization, and all ruptured at the time of diagnosis. Subsequent pregnancy was achieved in ten patients. No uterine rupture was encountered during pregnancy or labor | Ipsilateral salpingectomy, previous ectopic pregnancy, and in vitro fertilization are predisposing factors for interstitial pregnancy. Contrary to previous belief, rupture of interstitial pregnancy occurs relatively early in pregnancy. In selected patients, laparoscopic cornual excision is a viable treatment option. |
| Warda 2014 (24) | Case series | N/A | Cases of interstitial ectopic pregnancy | 4 | Laparoscopic cornuostomy and removal of products of conception, (3) | Cornuostomy by laparotomy, (1) | Transvaginal ultrasound scan and diagnostic laparoscopy | Subsequent successful reproductive outcomes are presented. | Progressively conservative surgical measures are being used to treat interstitial pregnancy successfully, with no negative impact on subsequent pregnancies. |