Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Tubal Stump Pregnancy

Abstract

Objective: To demonstrate a case of left tubal stump pregnancy successfully treated using our 2-step technique for transvaginal natural orifice transluminal endoscopic surgery (vNOTES). Design: Demonstration of the technique using surgical video footage. Setting: Tertiary university hospital. Interventions: 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 b 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. Conclusion: 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.

Easy way to perform salpingectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) (with video)

“…The transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is a new minimally invasive procedure (MIP) in which the vagina is used as a natural access to the peritoneal cavity and enables endoscopic surgery with conventional laparoscopic instruments. Several studies have demonstrated the feasibility and safety on vNOTES with many advantages leading to a day-care or ambulatory procedure: reduced immediate postoperative pain, faster postoperative recovery, better cosmetic results without skin scar, high patient satisfaction [1][2][3][4][5][6][7][8][9][10][11]. Some studies have also shown the superiority of vNOTES in comparison with the classical laparoscopic surgery in term of lower postoperative pain scores and the absence of trocar-site complications [10,11].…”

Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in gynecological emergencies

“…Some authors reported successfully using vNOTES to manage tubal ectopic pregnancy, adnexal torsion, ovarian cyst rupture, and pelvic inflammatory disease [1] , [2] , [3] , [8] , [12] . Similarly, we were able to manage gynecological (ectopic pregnancies, adnexal torsions, painful ovarian cysts, post-hysterectomy hemoperitoneum, and uncontrollable uterine bleeding) and non-gynecological (appendicitis) emergencies by vNOTES in 17 patients.…”

“…In the last decades, minimally invasive techniques have been increasingly used in emergency surgery, considerably reducing the morbidity associated with open approaches. To minimize surgical morbidity further, some authors proposed to manage gynecological emergencies by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) [1] , [2] , [3] .…”