Journal List > Korean J Obstet Gynecol > v.53(8) > 1006457

Eom, Roh, Lee, Joo, Lee, You, and Yoo: Transumbilical single-port access laparoscopic surgery of ectopic pregnancy

Abstract

Objective

To evaluate the effectiveness of transumbilical single-port access laparoscopic surgery of ectopic pregnancy.

Methods

Retrospective analysis was performed on six patients who underwent transumbilical single-port access laparoscopic management of ectopic pregnancies.

Results

The median age of 6 cases was 33.5 years (range, 32 to 36), and the median body mass index was 20.6 kg/m2 (range, 16.5 to 28.7). The median largest diameter of G-sac was 4.8 cm (range, 3.0 to 5.4). Intracorporeal rupture and hemoperitoneum were accompanied in all cases. The median time needed for the surgery was 77.5 minutes (range, 59 to 95). The median estimated blood loss was 40 mL (range, 20 to 50). The median postoperative hospital day was 2 days (range, 1 to 3). There were no complications on postoperative course and follow-up.

Conclusion

Transumbilical single-port access laparoscopic surgery for ectopic pregnancy was feasible and safe. This approach might be reasonable alternative to conventional laparoscopic surgery using 3 or 4 port in the management of ectopic pregnancy.

Figures and Tables

Fig. 1
(A) Preparation of single umbilical port. ① An ALEXIS® wound retractor XS was inserted through the umbilicus. ② The wrist portion of a 6 1/2 glove wrapped the retractor, and 3 trocars (5 mm, 10 mm, 5 mm) were inserted into the fingers of the glove and tied. (B), (C) 5 mm endoscope, suction irrigator and flexible instruments (Roticulator®, Covidien, Mansfield, MA; Real Hand®, Novare Surgical System, Cupertino, CA, USA) were inserted through single umbilical port.
kjog-53-720-g001
Fig. 2
Intraoperative view of transumbilical single port laparoscopic salpingectomy. (A) Left tubal pregnancy and hemoperitoneum. (B) Rupture of left tubal pregnancy was identified. (C) Left salpinx was being resected. (D) The left salpinx was surgically resected and the hematoma was evacuated.
kjog-53-720-g002
Fig. 3
Postoperative umbilical wound after two months later. It is hard to find skin incision scar in umbilicus.
kjog-53-720-g003
Table 1
Clinical Features of 6 Patients with ectopic pregnancy
kjog-53-720-i001

BMI: body mass index, EBL: estimated blood loss, LS: left salpingectomy, RS: right salpingectomy, Operation time: defined from skin to skin, Hemoglobin change: diminution of hemoglobin between preoperative and postoperative 1-day value.

References

1. Ory SJ. New options for diagnosis and treatment of ectopic pregnancy. JAMA. 1992. 267:534–537.
2. Vermesh M, Silva PD, Rosen GF, Stein AL, Fossum GT, Sauer MV. Management of unruptured ectopic gestation by linear salpingostomy: a prospective, randomized clinical trial of laparoscopy versus laparotomy. Obstet Gynecol. 1989. 73:400–404.
3. Brzezinski A, Schenker JG. Current status of endoscopic surgical management of tubal pregnancy. Eur J Obstet Gynecol Reprod Biol. 1994. 54:43–53.
4. Silva PD. A laparoscopic approach can be applied to most cases of ectopic pregnancy. Obstet Gynecol. 1988. 72:944–947.
5. Henderson SR. Ectopic tubal pregnancy treated by operative laparoscopy. Am J Obstet Gynecol. 1989. 160:1462–1466.
6. Lundorff P, Thorburn J, Hahlin M, Kallfelt B, Lindblom B. Laparoscopic surgery in ectopic pregnancy. A randomized trial versus laparotomy. Acta Obstet Gynecol Scand. 1991. 70:343–348.
7. Kim YW. Single port transumbilical total laparoscopic hysterectomy (TLH): initial experience in Korea. Korean J Obstet Gynecol. 2009. 52:480–486.
8. Pelosi MA, Pelosi MA 3rd. Laparoscopic hysterectomy with bilateral salpingo-oophorectomy using a single umbilical puncture. N J Med. 1991. 88:721–726.
9. Canes D, Desai MM, Aron M, Haber GP, Goel RK, Stein RJ, et al. Transumbilical single-port surgery: evolution and current status. Eur Urol. 2008. 54:1020–1029.
10. Cartwright PS. Jones HW, Wentz AC, Burnett LS, editors. Ectopic pregnancy. Novak's textbook of gynecology. 1988. 11th ed. Baltimore: Williams & Wilkins;479–506.
11. Breen JL. A 21 year survey of 654 ectopic pregnancies. Am J Obstet Gynecol. 1970. 106:1004–1019.
12. Park S, Na Y, Jung J, Yang S, Choi S, Kim S, et al. A clinical study of ectopic pregnancy during recent 8 years. Korean J Obstet Gynecol. 2009. 52:245–252.
13. Ko YC, Lee H, Choi WI, Choi SE, Lee YI, Cho TI. A comparison of laparoscopy and laparotomy for the treatment of ectopic pregnancy. Korean J Obstet Gynecol. 2005. 48:176–181.
14. Tait RL. Five cases of extrauterine pregnancy operated upon at the time of rupture. Br Med J. 1984. 1:1250–1254.
15. Shapiro HI, Adler DH. Excision of an ectopic pregnancy through the laparoscope. Am J Obstet Gynecol. 1973. 117:290–291.
16. DeCherney AH, Diamond MP. Laparoscopic salpingostomy for ectopic pregnancy. Obstet Gynecol. 1987. 70:948–950.
17. Stovall TG, Ling FW, Gray LA, Carson SA, Buster JE. Methotrexate treatment of unruptured ectopic pregnancy: a report of 100 cases. Obstet Gynecol. 1991. 77:749–753.
18. Bozzini P. Lichteiter, eine efridung zur anschung innerer theile und krankheitennebst abbildung. Pract Arzerykunde. 1806. 24:107–109.
19. Ott D. Die beleuchtung der bauchhole (ventroskopie) als metode bei vaginaler coeliotomie. Abl Gynekol. 1902. 231:817–821.
20. Reich H, Freifeld ML, McGlynn F, Reich E. Laparoscopic treatment of tubal pregnancy. Obstet Gynecol. 1987. 69:275–279.
21. Reich H. Laparoscopic treatment of extensive pelvic adhesions, including hydrosalpinx. J Reprod Med. 1987. 32:736–742.
22. Zouves C, Urman B, Gomel V. Laparoscopic surgical treatment of tubal pregnancy. A safe, effective alternative to laparotomy. J Reprod Med. 1992. 37:205–209.
23. Pelosi MA, Pelosi MA 3rd. Laparoscopic appendectomy using a single umbilical puncture (mini-laparoscopy). J Reprod Med. 1992. 37:588–594.
24. Pelosi MA, Pelosi MA 3rd. Laparoscopic supracervical hysterectomy using a single-umbilical puncture (mini-laparoscopy). J Reprod Med. 1992. 37:777–784.
25. Kim TJ, Lee YY, Kim MJ, Kim CJ, Kang H, Choi CH, et al. Single port access laparoscopic adnexal surgery. J Minim Invasive Gynecol. 2009. 16:612–615.
26. Lee YY, Kim TJ, Kim CJ, Kang H, Choi CH, Lee JW, et al. Single-port access laparoscopic-assisted vaginal hysterectomy: a novel method with a wound retractor and a glove. J Minim Invasive Gynecol. 2009. 16:450–453.
TOOLS
Similar articles