Early experience with isobaric laparoendoscopic single-site surgery using a wound retractor for the management of ectopic pregnancy.
OBJECTIVE
To report our initial experience with isobaric (gasless) transumbilical laparoendoscopic single-site (LESS) surgery using a wound retractor for the management of ectopic pregnancy.


METHODS
Twelve consecutive cases of ectopic pregnancy were managed by isobaric LESS surgery with the subcutaneous abdominal wall-lift method. In each case, a wound retractor was used as a transumbilical working port with insertion into the peritoneal cavity through a 2.5-cm vertical umbilical incision. Subsequent surgical procedures were performed with multiple conventional laparoscopic instruments through single umbilical port.


RESULTS
All cases of ectopic pregnancy were successfully managed by isobaric LESS surgery. Procedures included salpingectomy in eight cases of ampullary pregnancy and two cases of isthmic pregnancy, salpingectomy and local methotrexate injection in one case of isthmic pregnancy, and salpingo-oophorectomy for one case of ovarian pregnancy. Neither extraumbilical incisions nor conversion to laparotomy was required. In a case of ruptured ampullary pregnancy with massive hemoperitoneum, intraoperative autologous blood salvage and donation avoided the need for the transfusion of bank blood. Although postsurgical umbilical seroma was noted in one case and systemic methotrexate administration was required for persistent ectopic pregnancy in one case of isthmic pregnancy respectively, there were no major surgical complications in this series. The technique yielded excellent cosmetic results with minimum postoperative scar concealed within umbilicus. Retrospective comparison of surgical parameters including surgical duration, estimated blood loss, frequency of postoperative analgesic use, time of bowel recanalization, postoperative inflammatory response and postoperative hospital stay did not show any significant differences between isobaric LESS surgery group and conventional isobaric multiport laparoscopic surgery group.


CONCLUSIONS
Based on the satisfactory outcome achieved in these initial 12 cases of ectopic pregnancy treated by isobaric LESS surgery, the wound retraction system combined with the subcutaneous abdominal wall-lift method appears to contribute favorably to LESS surgery for the management of ectopic pregnancy because the device permits free circumferential access and retraction during procedures without the closed condition required during pneumoperitoneum.
Department of Obstetrics & Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan. gyendoscopy@gmail.com
Akihiro
A
Takeda
Sanae
S
Imoto
Masahiko
M
Mori
Tomoko
T
Nakano
Hiromi
H
Nakamura
D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000601:surgery*; D058994:Salpingectomy / Q000379:methods; D016896:Treatment Outcome; D014472:Umbilicus