Treatment of hepatic ectopic pregnancy by laparoscopy

To demonstrate the laparoscopic surgical treatment of hepatic ectopic pregnancy through a video.

The procedure was performed at the Department of Gynecology, Shanghai First Maternity and Infant Hospital.

A 34-year-old nulligravida woman was admitted with amenorrhea for 5 weeks and 6 days, irregular vaginal bleeding for over half a month, and right upper quadrant pain. She had no prior surgical history and no identifiable high-risk factors for ectopic pregnancy.

The procedure commenced with exploration of the pelvic cavity, followed by dissection of the falciform ligament. Adhesions between the ligament and the abdominal wall were separated using bipolar electrocoagulation. The round ligament of the liver was then clipped and transected with a Hem-o-lok clip to achieve prophylactic hemostasis and improve surgical exposure. Following mobilization of adherent tissues, the plane between the gestational mass and normal liver parenchyma was defined. The lesion was enucleated along this plane using an ultrasonic scalpel and blunt dissection. The intact specimen was retrieved in an endoscopic bag via an extended 12-mm port for pathology. IRB exemption has been obtained for this study, with relevant documents uploaded separately.

In this case, laparoscopic complete resection of a hepatic ectopic pregnancy was successfully performed within 115 minutes, with an estimated blood loss of 50 mL. Serial postoperative serum hCG levels demonstrated a rapid decline: 146.3 IU/L on day 4, decreasing to 80.2 IU/L on day 6, and nadiring at 11.8 IU/L by day 11, with subsequent confirmation of a negative result. The pathological examination confirmed the diagnosis [1]. The key surgical principle is complete lesion enucleation with adhesiolysis to avoid catastrophic hemorrhage [2]. This report demonstrates that a laparoscopic "direct approach" is an effective and minimally invasive strategy for superficial, resectable hepatic ectopic pregnancies, with close postoperative β-hCG monitoring and imaging follow‑up being crucial to confirm complete resolution. VIDEO ABSTRACT.