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Tubal Pregnancy with Acute Bleeding Treated by Laparoscopic Surgery: Tips and Case Presentation

Laparoscopic surgery is the standard surgical approach for ectopic 
pregnancy. However, some surgeons prefer laparotomy for patients with acute 
bleeding. We evaluated four cases of tubal pregnancy with massive 
hemoperitoneum (>800 ml) and performed laparoscopic surgery. The patient age 
ranged from 20 to 37 years, and the gestational age ranged from 5 to 8 weeks. 
All cases were hemodynamically unstable. Two cases had hemoperitoneum of 
>2000 mL, which was caused by the rupture of the left isthmus tube. In three 
cases, surgery could be started within approximately 30 min, and in one case, 
the start time extended owing to difficulty in anesthesia introduction. 
Moreover, in three cases, the target lesion was reached within 7 min, and the 
lesion was excised in approximately 20 min from the start of insufflation, and 
in one case with a lesion exceeding 7 cm, the time extended. All patients were 
safely treated via laparoscopic surgery. To initiate surgery without 
deterioration of the hemodynamic condition, blood transfusion can be started 
simultaneously with preparation for laparoscopic surgery. Lifting the lesion with 
a pair of forceps can help immediately stop bleeding, even if it is difficult 
to secure the visual field owing to massive bleeding. When there is difficulty in anesthesia or a large pregnancy lesion, care should be taken to avoid an 
increase in the amount of bleeding associated with extension of the 
perioperative period.