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 two-step technique for transvaginal natural orifice transluminal endoscopic surgery (vNOTES). Design Demonstration of the technique using surgical video footage. Setting A tertiary university hospital. Intervention A 27-year-old G3P0 patient with a history of laparotomy, left salpingectomy, due to a ruptured tubal pregnancy was referred to our hospital due to pregnancy of unknown location. Her serum beta human chorionic gonadotropin level was 8,400 U/L and transvaginal ultrasound revealed an ectopic pregnancy in the left tubal stump. After discussing medical and surgical treatment options, the patient underwent a two-step vNOTES approach. First, a diagnostic vNOTES was performed using a 5-mm trocar with auto-retracting blade. After the confirmation of 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 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 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.