Tubal Pregnancy with Acute Bleeding Treated by Laparoscopic Surgery: Tips and Case Presentation

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Laparoscopic surgery is the standard surgical approach for ectopic pregnancy. However, some surgeons prefer laparotomy for patients with acute bleeding. We evaluated four cases of tubal pregnancy with massive hemoperitoneum (>800 ml) and performed laparoscopic surgery. The patient age ranged from 20 to 37 years, and the gestational age ranged from 5 to 8 weeks. All cases were hemodynamically unstable. Two cases had hemoperitoneum of >2000 mL, which was caused by the rupture of the left isthmus tube. In three cases, surgery could be started within approximately 30 min, and in one case, the start time extended owing to difficulty in anesthesia introduction. Moreover, in three cases, the target lesion was reached within 7 min, and the lesion was excised in approximately 20 min from the start of insufflation, and in one case with a lesion exceeding 7 cm, the time extended. All patients were safely treated via laparoscopic surgery. To initiate surgery without deterioration of the hemodynamic condition, blood transfusion can be started simultaneously with preparation for laparoscopic surgery. Lifting the lesion with a pair of forceps can help immediately stop bleeding, even if it is difficult to secure the visual field owing to massive bleeding. When there is difficulty in anesthesia or a large pregnancy lesion, care should be taken to avoid an increase in the amount of bleeding associated with extension of the perioperative period.