To explore the feasibility and safety of laparoendoscopic single-site surgery for type Ⅲ (masses) uterine scar pregnancy.

The clinical data of 4 patients who underwent single port laparoscopic uterine artery temporary ligation+ uterine scar pregnancy lesion resection+ cesarean section scar diverticulum repair in the Department of Gynecology, Changzhou Second People′s Hospital, Nanjing Medical University were retrospectively analyzed. In 4 patients, mass pregnancy lesions were found in the cesarean section scar in the lower part of the uterus, all of which protruded to the bladder, and the muscle layer was obviously thinned. All 4 patients underwent single port laparoscopy combined with hysteroscopy to complete the operation. The length of the umbilical hole is about 1.5 cm in length through the middle of the umbilical hole. A special disposable single-port laparoscope is used to operate the soft sheath to form the operating channel, and the laparoscopic operating instrument is inserted to perform the operation.

The operations of the 4 patients in this group were all successfully completed, none of them increased access to traditional laparoscopic surgery nor switched to laparotomy. All 4 patients underwent single port laparoscopic uterine artery temporary ligation + uterine scar pregnancy lesion resection+ in cesarean section scar diverticulum repair, the ureter, intestine, bladder and other nearby organs were not injured during the operation, nor were large blood vessels and nerves injured. After temporary ligation of bilateral uterine arteries, the blood supply of uterine arteries was normal. The operation time in this group was 170-210 min, average (188.75±15.16)min, intraoperative blood loss was 30-90 ml, average (62.50±23.85)ml, preoperative hemoglobin (106.00±21.81)g/L postoperative hemoglobin (96.00±13.42)g/L, the body temperature of 4 patients was 37.1-37.6℃ on the first postoperative day, and the anus was exhausted from 1-1.5 days. There was no urinary retention when the catheter was removed on the postoperative day. No analgesic drugs were required after operation. The incision healing was grade a and no incisional hernia occurred. One patient in this group received the scar approach from the cesarean section, and the other three received the umbilical approach. After the wound has healed, the " beauty" effect is good. The patients were hospitalized for 4-5 days after the operation and were discharged without complications. The curative effect of the patients in this group was satisfactory, the HCG decreased significantly when discharged from the hospital, and the outpatient follow-up gradually turned negative. The patient recovered well after the operation and is still under follow-up observation.

Under the premise of mature laparoscopic techniques, the selection of appropriate cases, LESS for type Ⅲ (masses) uterine scar pregnancy may be safe and effective.