Transumbilical single-hole laparoscopic treatment of cesarean scar pregnancy by uterine artery pre-ligation: a report of 4 cases

Abstract

Transumbilical single-hole laparoscopic treatment of cesarean scar pregnancy by uterine artery pre-ligation: a report of 4 cases Xin Du1,2, * , Qian Zou1 , Yu-Lan Liu1 1Department of Gynecology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, 430070 Wuhan, Hubei, China 2Hubei Provincial Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, 430065 Wuhan, Hubei, China *Correspondence: dongxin@hbfy.com (Xin Du) DOI:10.31083/j.ceog4805167 This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/). Submitted: 15 November 2020 Revised: 24 December 2020 Accepted: 14 January 2021 Published: 15 October 2021 Background: To explore the safety and feasibility of transumbilical single-hole laparoscopic treatment of cesarean scar pregnancy (CSP) by uterine artery pre-ligation. Methods: Four cases with type II or III CSP were collected. Under transumbilical single-hole laparoscope, an active knot was first made around the uterine artery. If excessive bleeding occurred, the active knot was tightened to control intraoperative bleeding. Excessive bleeding was defined as more than 50 mL of bleeding within 2 min that failed to respond to electrocoagulation. Results: The active knot was tightened in two of the four cases. Overall, the mean intraoperative bleeding was 175.00 ± 155.456 mL, mean operation duration was 171.00 ± 17.455 min, mean postoperative hospitalization was 4.50 ± 0.577 days, and the mean time required for postoperative serum β-HCG to return to normal level was 27.50±5.196 days. Menstruation recovered in 40.25±16.112 days after operation, while postoperative menstrual volume was less in one case and otherwise normal. Conclusions: For the treatment of type II or III CSP, transumbilical single-hole laparoscope combined with uterine artery pre-ligation can accurately control and reduce intraoperative bleeding in place of uterine artery embolization. This treatment regimen is safe and may obtain better abdominal appearance. Keywords Cesarean scar pregnancy; Single-hole laparoscope; Uterine artery pre-ligation