Laparoscopy combined with hysteroscopy for cesarean scar pregnancy

Abstract

Laparoscopy combined with hysteroscopy for cesarean scar pregnancy L.B. Liu1 , H.T. Sun1 , S.F. Liu1,∗ , R.X. Shi1,∗ 1The Second People’s Hospital of Changzhou, Nanjing Medical University, Changzhou, Jiangsu Province, 213000 (P.R. China) Summary Purpose: The aim of this study was to investigate the safety of combined laparoscopic surgery and hysteroscopic electrosurgery for partial repair of the cesarean scar and removal of the conceptus, respectively, in cesarean scar pregnancy (CSP). Methods: This was a retrospective analysis of data from 23 patients with CSP who underwent laparoscopic surgery together with hysteroscopic electrosurgery between January 2008 and January 2016 at our medical center. Under hysteroscopic visualization, the gestational sac and the complete cesarean section scar were cut by laparoscopic surgery. Results: Patient age was 28 ± 3.3 years (mean ± SD) with a range of 22-38 years. Patient gravidity was 3.0 ± 1.2 with a range of 1-6, while parity was 1.0 ± 1.5 with a range of 1-3. Intraoperative blood loss was 100.2 ± 32.7 mL (mean ± SD), operating time was 60 ± 48.6 min and the duration of hospitalization was 5 ± 1.2 days. Surgery was successful in all patients, with no instances of bladder injury. The level of β-human chorionic gonadotropin (β-HCG) began to decrease on the second postoperative day and returned to normal levels within one month of surgery. The mean time required for normalization of serum β-HCG levels was 25 ± 5.2 days (mean ± SD) with a range of 20-35 days. Conclusions: Laparoscopic surgery combined with hysteroscopic electrosurgery for partial repair of the cesarean scar and removal of the conceptus, respectively, is a safe, feasible and effective treatment approach for CSP. Key words: Cesarean scar pregnancy (CSP); Laparoscopy; Hysteroscopy