Repeated ectopic pregnancy on the tubal stump after laparoscopic salpingectomy

A 40-year-old woman who had undergone laparoscopic right salpingectomy because of a tubal pregnancy 10 years ago presented to our hospital with severe lower abdominal pain. Ectopic pregnancy with internal bleeding was suspected after evaluation. With laparoscopy, repeated ectopic pregnancy on the tubal stump was diagnosed and treated successfully.     

Comparison of single-port and three-port laparoscopic salpingectomy in the management for tubal pregnancy

Background

To compare the short-term outcome of patients undergoing single-port laparoscopic salpingectomy (SP-LS) and conventional three-port laparoscopic salpingectomy (C-LS).

Transvaginal Endoscopic Surgery for Tubal Ectopic Pregnancy

Objective:

To explore the feasibility, safety, efficacy, and cosmetic outcomes of transvaginal endoscopic salpingectomy for tubal ectopic pregnancy.

Methods:

From May 2009 to May 2012, we prospectively enrolled 40 patients, each of whom had been scheduled for a salpingectomy because of a tubal ectopic pregnancy, and randomized them into two groups: transvaginal endoscopic surgery and laparoscopic approach. We recorded the estimated blood loss, time of anal exhaust, postoperative pain score, length of stay, and scar assessment scale associated with transvaginal endoscopic access (n = 18) (natural orifice transluminal endoscopic surgery) and laparoscopic salpingectomy (n = 20) (control group) for tubal ectopic pregnancy. The transvaginal salpingectomy was performed with a double-channel endoscope through a vaginal puncture. A single surgeon performed the surgical procedures in patients in both groups.

Results:

The group that underwent the transvaginal endoscopic procedure reported lesser pain at all postoperative visits than the group that underwent the laparoscopic approach. The duration of time for transvaginal endoscopic surgery was slightly longer than that for the laparoscopic approach. However, there was no statistically significant difference between the two groups in the duration of operative time. The group that underwent transvaginal endoscopic surgery was more satisfied with the absence of an external scar than the group that underwent the laparoscopic procedure, which left a scar. The estimated blood loss, time of anal exhaust, and length of stay were the same in both groups.

Conclusion:

The safety and efficacy of transvaginal endoscopic salpingectomy for tubal ectopic pregnancy are equivalent to those of the laparoscopic procedure. Lesser postoperative pain and a more satisfactory cosmetic outcome were found with the transvaginal endoscopic procedure, making it the more preferred method and superior to the laparoscopic approach.     

输卵管积水对人类辅助生殖的影响及处理对策

输卵管积水可能通过胚胎毒性、改变子宫内膜容受性、机械性冲刷等机制影响IVF-ET妊娠结局。目前输卵管积水的处理方式主要有：输卵管切除术、输卵管结扎术、经阴道超声引导下输卵管积水抽吸术、输卵管栓塞术、抗生素抗感染。     

不同方法治疗输卵管妊娠后生育结局的临床分析

目的评价不同方法治疗输卵管妊娠后的生育能力.方法回顾性分析176例首次输卵管妊娠患者经手术治疗和药物保守治疗后的生育状态,比较手术治疗与药物治疗、输卵管保守手术与根治性手术、腹腔镜手术与开腹手术之间的区别.结果宫内妊娠率在手术组为59.6%,在药物治疗组为52.8%,两组重复异位妊娠率分别为14.4%和13.9%,两组不孕率分别为26.0%和33.3%,较差异无统计学意义（P〉0.05）;宫内妊娠率在输卵管保守手术组为62.5%,在根治手术组为55.0%,两组重复异位妊娠率分别为17.2%和10.0%,两组不孕率分别为20.3%和35.0%,差异无统计学意义（P〉0.05）;宫内妊娠率在腹腔镜手术组为69.8%,在开腹组为43.9%,两组重复异位妊娠率分别为12.7%和17.1%,两组不孕率分别为17.5%和39.0%,差异有统计学意义（P〈0.05）.结论输卵管妊娠可根据具体情况行手术治疗或者药物治疗;手术治疗应尽量选择腹腔镜手术;输卵管病情是决定手术方式的关键因素,应以保护患者生育能力,解除不孕隐患为原则.     

Laparoscopic management of transcervical fallopian tube prolapse

Introduction:

Fallopian tube prolapse (FTP) is a rare but increasingly recognized postoperative complication of total hysterectomy, but few reports relate FTP to supracervical hysterectomy.

Case:

A 35-year-old, G2P2, patient with a history of recurrent fibroid prolapse received a supracervical hysterectomy. One week postoperatively, she was treated for infection, and 1 month later a scheduled Pap smear returned benign results and noted a rare cluster of glandular cells. Two months after the hysterectomy, the patient presented to the outpatient clinic with vaginal discharge and dyspareunia. The patient was diagnosed with FTP and was treated with total salpingectomy using a combined vaginal and laparoscopic approach.

Conclusion:

Transcervical FTP is a rare complication following supracervical hysterectomy. Increasing awareness of the condition will allow for fewer delays in diagnosis and treatment. A laparoscopic total salpingectomy provides effective treatment with minimal invasiveness.     

The Use of Opportunistic Salpingectomy at the Time of Benign Hysterectomy

Study Objective

To delineate the use of opportunistic salpingectomy over the study period, to examine factors associated with its use, and to evaluate whether salpingectomy was associated with perioperative complications.

Tubal ectopic pregnancy: diagnosis and management

Ectopic pregnancy is the gynaecological emergency par excellence and remains the leading cause of pregnancy-related first trimester deaths in the UK. Its prevalence continues to rise because of increases in the incidence of the risk factors predisposing to ectopic pregnancy. Classically, the diagnosis is based on a history of pelvic pain associated with amenorrhoea, a positive pregnancy test with or without slight vaginal bleeding. While the immediate differential diagnosis includes threatened or inevitable miscarriage, the likelihood of ectopic pregnancy is increased if transvaginal sonography (TVS) reveals an empty uterine cavity, and is confirmed if an adnexal mass with or without an embryo is seen. However, the diagnosis is often not that simple, especially when the patient presents early, has minimal pain, is haemodynamically stable, and TVS shows an empty uterus but no obvious adnexal mass. This could then be an early intrauterine pregnancy, or could indeed be an ectopic—a diagnosis of pregnancy of unknown location is made while additional investigations are made. The latter usually include serial measurements of serum beta human chorionic gonadotrophin (beta-hCG) and repeat TVS. Changes in beta-hCG levels in normal, failing and ectopic pregnancy are now reasonably well characterised, and at early stages of presentation where the risk of rupture of an ectopic are minimal, the patient can often be managed as an outpatient while the diagnosis is pursued. In the patient who presents with pain and haemodynamic instability, the diagnosis is often obvious, and the management is immediate laparotomy. However, in modern gynaecological practice in the developed world the vast majority of ectopic pregnancies present early, and the general consensus is that laparoscopic management offers both economic and aesthetic advantages, and should be used whenever possible. Salpingectomy (excision of the fallopian tube containing the ectopic) is performed if the contra-lateral tube is healthy, while salpingotomy (linear incision made in the fallopian tube with removal of ectopic pregnancy and conservation of tube) is performed if the contra-lateral tube is unhealthy. Medical therapy using methotrexate given systemically or injected directly into the ectopic pregnancy is an option occasionally used with good results. There appear to be no major differences in subsequent fertility outcomes, or risk of recurrence of ectopic pregnancy, between the surgical or medical treatments. Although the rates of ectopic pregnancy are not falling in the developed world, mortality and morbidity are falling mainly due to early and improving diagnostic and treatment modalities. Mass screening and treatment of Chlamydia in the young, sexually active populations, and education regarding risk factors, may in future result in a reduction in the rates. Lack of resource mean that the picture may remain dismal for some time to come in the developing world, but the development of basic protocols, improved training and the infusion of basic resources may go a long way to improving the situation.     

The Trend,Feasibility, and Safety of Salpingectomy as a form of Permanent Sterilization

Study ObjectiveTo assess the change in the rate of laparoscopic salpingectomy for sterilization after the release of the November 2013 Society of Gynecologic Oncology Clinical Practice Statement and the January 2015 American College of Obstetricians and Gynecologists Committee Opinion: Salpingectomy for Ovarian Cancer Prevention. We hypothesized there would be an increase in salpingectomy as a percentage of total laparoscopic sterilizations performed without an increase in complications when compared with conventional bilateral tubal ligation (BTL).DesignA retrospective cohort study.SettingFour university-affiliated hospitals in Houston, TX, and New York, NY.PatientsAll women 21 years or older who underwent interval laparoscopic permanent sterilization between April 2013 and September 2016.InterventionsSterilization by bilateral salpingectomy or conventional tubal ligation.Measurements and Main ResultsThere were 454 sterilization procedures identified; 60% were BTLs, whereas 40% were salpingectomies. The rate of use of salpingectomy significantly increased from 5% to 9% in 2013 to 2014 to 78% by 2016. There was no significant difference in intraoperative or postoperative complications or estimated blood loss. The mean procedure time was 54 minutes for salpingectomy compared with 45 minutes for BTL (p <.0001). Salpingectomy was more likely to require 3 ports compared with 2 ports for BTL (p <.0001).ConclusionsThe Society of Gynecologic Oncology and the American College of Obstetricians and Gynecologists’ support of salpingectomy for ovarian cancer prevention increased its use for sterilization. Based on this study, laparoscopic bilateral salpingectomy is a safe method of sterilization without an increase in perioperative risk compared with conventional tubal ligation. Physicians should incorporate these findings and implications when counseling patients regarding contraception and permanent sterilization.     

Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Tubal Pregnancy and a Device Innovation from Our Institution

Natural orifice transluminal endoscopic surgery (NOTES) is a relatively new technique currently being studied around the world. Between June 2015 and June 2017, 12 patients diagnosed with ectopic pregnancy underwent transvaginal NOTES to remove their fallopian tubes. All 12 surgeries were completed successfully. The median age of patients was 33years (range, 28–42), and the median body mass index was 23.47 (range, 20.55–27.68). The median duration of amenorrhea was 53days (range, 41–60). The median serum β-human chorionic gonadotropin was 8887 U/mL (range, 392–25 695). The median ectopic mass longest diameter was 2.95 cm (range, 2.1–5.0). The median surgical time was 47.5 minutes (range, 40–70). The median hemoperitoneum was 52.5 mL (range, 20–300), and the median blood loss was 7.5 mL (range, 2–20). Our study has proven the feasibility and repeatability of transvaginal NOTES for less difficult ectopic pregnancies. The success of transvaginal NOTES lies in the choice of patients and the establishment of the transvaginal operating platform. We added a plastic ring between the inner and outer rings outside the wound retractor. The modified platform can lessen the technical difficulties of performing transvaginal NOTES and broaden its applicability to other procedures.