LAUSR

OBJECTIVE To demonstrate how a heterotopic tubal stump pregnancy can be safely managed with laparoscopy, preserving the intrauterine pregnancy. DESIGN Stepwise demonstration of the technique by means of a video tutorial. SETTING The management of pregnancies in the tubal stump after salpingectomy involves either a surgical intervention or a systemic therapy. In case of a simultaneous intrauterine pregnancy, whereas the prognosis for the fetus remains good, with live births in about 70% of cases, the surgical management of the tubal stump pregnancy is challenging due to the risk of bleeding from the uterine horn. We present an effective and reproducible laparoscopic technique on the basis of a 31-year-old patient with 2 prior right fallopian tube pregnancies, the later treated with salpingectomy. The patient is now presenting in the 6th week of gestation after transfer from 2 oocytes with a pregnancy in the tubal stump and a concomitant vital intrauterine pregnancy. INTERVENTION The key steps of laparoscopic surgery include: 1. Continuous absorbable monofilament suture on the uterine horn around the tubal stump to achieve hemostasis and exposure of the proximal part of the tube 2. Removal of ectopic pregnancy 3. Closure of the excision site with continuous absorbable polyfilament suture The instillation of vasoconstrictive substances and the use of electrical coagulation should be avoided. CONCLUSION The demonstrated laparoscopic technique is a feasible method of removal of a tubal stump pregnancy without interfering with the vital intrauterine pregnancy. The blood loss can be minimized and laparotomy can be avoided. Institutional review board approval: This study is exempt from institutional review board approval, according to the institutional review board of the University of Würzburg (reference number 20200504 02).