Trans-umbilical single-port laparoscopic excision of intramural pregnancy

Intramural pregnancy (IMP) is a rare type of ectopic pregnancy, in which the gestational sac is completely embedded in uterine myometrium, unconnected with uterine cavity and fallopian tubes. Due to its potentially fatal hemorrhage and uterine rupture, early diagnosis and management of IMP are important to reduce the risk of hemorrhage as well as preserve patients' fertility. In most cases, IMP can be confirmed by ultrasound preoperatively, but some cases are identified eventually by laparoscopic surgery, which were initially suspected as tubal pregnancy. Different treatment modalities have been proposed for the management of IMP, such as laparoscopy and/or hysteroscopy. Trans-umbilical single-port laparoscopic surgery has emerged as a new concept of minimally invasive surgery and has flourished in the field of gynecology recently, with the advantage of being virtually scarless. In this article, we present this minimally-invasive method for the first time in a patient suspected as IMP at early pregnancy. She had undergone left salpingo-oophorectomy for ectopic pregnancy one year before. Ultrasonography showed that a gestational sac-like echo was detected in the left intermuscular wall, with yolk sac-like echoes visible within it, with positive human chorionic gonadotrophin level. The location of yolk sac was further determined by abdominal computed tomography scan. Surgery was performed successfully through a puncture hole approximately 2 cm in diameter in umbilicus. Before resecting the pregnancy lesion, low-dose pituitrin was used, inducing uterine contractions and decreasing uterine blood loss. Absorbable sutures were used to close the myometrial plasma layer. This minimally invasive surgery was performed successfully without any postoperative complications. The aim of the video of this study is to describe the use of this kind of surgery and share our experience for IMP.