Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey.
Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey.
J Minim Invasive Gynecol. 2021 Apr;28(4):750-751. doi: 10.1016/j.jmig.2020.06.026. Epub 2020 Jul 5.
To demonstrate a case of left tubal stump pregnancy successfully treated using our 2-step technique for transvaginal natural orifice transluminal endoscopic surgery (vNOTES).
Demonstration of the technique using surgical video footage.
Tertiary university hospital.
A 27-year-old gravida 3 para 0 patient with a history of laparotomy, left salpingectomy owing to a ruptured tubal pregnancy, was referred to our hospital because of a pregnancy of unknown location. Her serum β human chorionic gonadotropin level was 8400 U/L, and a transvaginal ultrasound revealed an ectopic pregnancy in the left tubal stump. After discussing medical and surgical treatment options, the patient underwent a 2-step vNOTES approach. First, a diagnostic vNOTES was performed using a 5-mm trocar with autoretracting blade. After confirmation of the diagnosis, the trocar was removed, and the incision was enlarged with blunt dissection. A self-constructed pessary port was then placed through the enlarged colpotomy, and the ectopic pregnancy in the left tubal stump was excised using an advanced bipolar device. The colpotomy was closed with running resorbable sutures. The duration of the surgery was 36 minutes, and the patient was discharged on postoperative day 1 without any complications.
Tubal stump pregnancy is a rare form of ectopic pregnancy with an incidence of approximately 0.4% of all ectopic pregnancies [1]. Treatment options include conservative medical management using methotrexate and surgery. Successful surgical treatment using laparoscopy has been previously reported [1,2]. This case demonstrates that vNOTES may be a minimally invasive option for the surgical treatment of tubal stump pregnancy in selected cases.
展示一例经阴道自然腔道内镜手术（vNOTES）两步技术成功治疗的左侧输卵管残端妊娠病例。
使用手术视频演示技术。
三级大学医院。
一位 27 岁的经产妇 3 次流产 0 次，因破裂的输卵管妊娠行剖腹手术切除左侧输卵管，因不明位置妊娠转至我院。其血清β人绒毛膜促性腺激素水平为 8400 U/L，经阴道超声显示左侧输卵管残端异位妊娠。在讨论了医疗和手术治疗方案后，患者接受了两步 vNOTES 方法治疗。首先，使用带有自动缩回刀片的 5mm trocar 进行诊断性 vNOTES。确诊后，取出 trocar，钝性分离扩大切口。然后通过扩大的阴道切口放置自制的支撑器端口，使用先进的双极器械切除左侧输卵管残端的异位妊娠。阴道切口用可吸收缝线连续缝合。手术时间为 36 分钟，患者术后第 1 天无并发症出院。
输卵管残端妊娠是一种罕见的异位妊娠形式，其发病率约为所有异位妊娠的 0.4%[1]。治疗方案包括使用甲氨蝶呤的保守药物治疗和手术治疗。既往有腹腔镜成功手术治疗的报道[1,2]。本病例表明，在选择的病例中，vNOTES 可能是输卵管残端妊娠的一种微创治疗选择。
