• cusum
• learning curve
• salpingectomy
• simp
• transumbilical laparoendoscopic single-site surgery
• tubal pregnancy
• tu-less

• Humans
• Female
• Learning Curve
• Retrospective Studies
• Laparoscopy/methods
• Laparoscopy/education
• Salpingectomy/methods
• Salpingectomy/education
• Adult
• Pregnancy
• Operative Time
• Pregnancy, Tubal/surgery
• Clinical Competence

The coexistence of a heterotopic pregnancy with a giant ovarian cyst is an incredibly rare abnormal pregnancy in cases of natural conception. The incidence of this condition has increased significantly as a result of the continuous development of assisted reproductive technologies. When this type of pregnancy occurs, both the continuation of intrauterine pregnancy and the life of the pregnant woman are severely threatened. Early diagnosis and treatment using safe and effective methods are paramount in this situation.

A 30-year-old primigravida at a gestation age determined as 8 wk 4 d by scan was admitted to the hospital with heterotopic pregnancy and a right ovarian cyst. Laparoscopic resection of the ectopic pregnancy was performed, but the intrauterine pregnancy and ovarian cyst were preserved.

The approach to a patient with heterotopic pregnancy and a giant ovarian cyst is individualized base on the fertility requirements. We recommend the following: (1) If the patient satisfies parity and has no fertility requirement, a laparoscopic salpingectomy should be performed and the giant ovarian cyst and intrauterine pregnancy removed; (2) If the patient has fertility requirements wishes to have more children in the future, laparoscopic salpingectomy or salpingostomy should be performed and the intrauterine pregnancy preserved. Serial ovarian cyst aspiration can be performed under ultrasound and resection can be done after delivery; and (3) Heterotopic pregnancy should be diagnosed early by active surveillance during antenatal visits using ultra sound as this is important for the avoidance of catastrophic complications.

• Heterotopic pregnancy
• Ectopic pregnancy
• Giant ovarian cyst
• Case report

• laparoscopy
• robotic surgical procedures
• uterine fibroids
• uterine myomectomy

Heterotopic pregnancy is the occurrence of pregnancies in at least two different implantation sites in the same time. The diagnosis of heterotopic pregnancy remains one of the greatest challenges of the gynecological-obstetrical emergencies.

We report a rare case of spontaneous heterotopic pregnancy of a 32-year-old woman, diagnosed with a heterotopic pregnancy by ultrasound and treated by laparotomy in emergency obstetrical department of Ibn Rochd University Hospital of Casablanca.

The existence of intrauterine pregnancy does not exclude an ectopic pregnancy. The occurrence of a spontaneous heterotopic pregnancy without risk factors is a rare event, the clinical symptomatology is often related to a threatened or ongoing abortion, the diagnosis of heterotopic pregnancy is not made until the appearance of signs of hemoperitoneum secondary to a ruptured EP, hence the importance of a systematic ultrasound examination of the adnexa during first trimester ultrasound. The standard treatment is conservative surgery, preferably by laparoscopy. Laparotomy retains its indications especially in forms with hemorrhagic shock. With the aim of preserving intrauterine pregnancy while removing ectopic pregnancy.

The diagnosis of heterotopic pregnancy should not be excluded by the discovery of a UGI in a spontaneous cycle. Diagnosis is often difficult and management should be initiated as soon as possible given the risk of maternal mortality.

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Heterotopic pregnancy is rare when at least two pregnancies are present simultaneously in different implantation sites.

• Ectopic pregnancy
• Heterotopic pregnancy
• Intrauterine pregnancy

• BRCA
• Salpigo-oophorectomy
• laparoscopy
• minilaparoscopy
• risk-reducing surgery

• hysterectomy
• laparoscopic single-site (LESS)
• multi-port robotic (MPR)
• pelvic organ prolapse (POP)
• robotic laparoendoscopic single-site (R-LESS)
• sacrocolpopexy

• Abdominal cerclage
• Adnexal mass
• Gynecologic surgery in pregnancy
• LESS
• Single-incision surgery

• Ectopic pregnancy
• laparoscopic-assisted surgery
• minimally invasive surgery
• salpingectomy

Single port laparoscopic surgery (SPLS) is an innovative approach that is rapidly gaining recognition worldwide. The aim of this study was to determine the feasibility and safety of SPLS compared to conventional laparoscopic surgery for the treatment of benign adnexal masses.

In total, 99 patients who underwent SPLS for benign adnexal masses between December 2013 and March 2015 were compared to a nonrandomized control group comprising 104 conventional laparoscopic adnexal surgeries that were performed during the same period. We retrospectively analyzed multiple clinical characteristics and operative outcomes of all the patients, including age, body mass index, size and pathological type of ovarian mass, operative time, estimated blood loss (EBL), duration of postoperative hospital stay, etc.

No significant difference was observed between the two groups regarding preoperative baseline characteristics. However, the pathological results between the two groups were found to be slightly different. The most common pathological type in the SPLS group was mature cystic teratoma, whereas endometrioma was more commonly seen in the control group. Otherwise, the two groups had comparable surgical outcomes, including the median operation time (51 min vs. 52 min, P = 0.909), the median decreased level of hemoglobin from preoperation to postoperation day 3 (10 g/L vs. 10 g/L, P = 0.795), and the median duration of postoperative hospital stay (3 days vs. 3 days, P = 0.168). In SPLS groups, the median EBL and the anal exsufflation time were significantly less than those of the conventional group (5 ml vs. 10 ml, P < 0.001; 10 h vs. 22 h, P < 0.001).

SPLS is a feasible and safe approach for the treatment of benign adnexal masses. Further study is required to better determine whether SPLS has significant benefits compared to conventional techniques.

To describe Higuchi’s transverse incision and a modification of this method for reduced port surgery (RPS).

Descriptive study.

University hospital.

Those with ovarian cyst and uterine myoma.

A platform is placed in the 2–3 cm Higuchi incision just above the pubis or on the pubis. Blunt dissection of the subcutaneous adipose tissue is performed. A T incision of the rectus abdominis fascia and a longitudinal incision of the peritoneum are performed. A LAP PROTECTOR and EZ access (Hakko Medical, Nagano, Japan) are used with the platform for single-incision laparoscopic surgery. The peritoneum and fascia are closed by continuous suture, and the skin is closed using the dermostitch technique.

Higuchi’s transverse incision is 2–3 cm in length and is made at a much lower position than the conventional Pfannenstiel transverse incision. The wound is covered by pubic hair, yielding an excellent esthetic outcome. The T incision of the rectus abdominis fascia secures a more extensive surgical field than the Pfannenstiel transverse incision.

Higuchi’s modified transverse incision ensures a sufficient visual field, yields an excellent esthetic outcome, and is safe, suggesting the potential use of this method for RPS.

• Higuchi’s transverse incision
• reduced port surgery
• single-incision laparoscopic surgery

• laparoscopically assisted myomectomy
• power morcellator
• reduced port surgery

• LESS
• conventional laparoscopic surgery
• ectopic pregnancy
• hemoperitoneum

Laparoscopic surgery is often used to excise adnexal masses; however, the retrieval of specimens such as large cystic masses through conventional 5- or 10-mm ports is difficult and time-consuming. We compared outcomes between conventional laparoscopic surgery for adnexal masses and transumbilical specimen retrieval through a multichannel port during single- or 2-port laparoscopy.

A total of 341 patients who underwent laparoscopic surgery for adnexal masses from November 2006 to December 2010 were included. The patients were divided into 2 groups: group I consisted of 249 patients who underwent conventional laparoscopy, and group II consisted of 92 patients who underwent single- or 2-port laparoscopy using a multichannel port. The clinical characteristics and operative outcomes of the 2 groups were compared.

The mean operation time was 51.8 ± 21.5 minutes in group I and 57.2 ± 23.9 minutes in group II. The mean specimen retrieval time was longer in group I (2.9 ± 4.0 minutes) than in group II (2.2 ± 1.8 minutes). Endoscopic bag rupture during specimen retrieval occurred in 11 patients in group I and in no patients in group II.

The transumbilical retrieval of surgical specimens through a multichannel port with a wound retractor was safe and did not result in leakage of the cystic contents. This technique reduced the specimen retrieval time, especially for large masses. However, the mean operation time was not shortened with this procedure, because of the learning period and the time required to prepare the umbilical multichannel port.

• Adnexa
• Laparoscopic surgery
• Multichannel port
• Transumbilical retrieval

• Laparoscopy
• Trocar fixation
• Trocar injury
• Trocar insertion
• Trocar movement

• Laparoendoscopic single-site surgery
• mimic laparoscopic surgery
• mini-laparoscopic surgery

Single-port transumbilical laparoscopic-assisted surgery for large, benign adnexal tumors was found to be a feasible alternative to conventional laparoscopic or open surgical methods.

To evaluate the efficiency and feasibility of single-port access transumbilical laparoscopic-assisted surgery in patients with large (>8cm) adnexal tumors and to present our initial experience.

Twenty-two patients with presumably benign adnexal tumors who have undergone single-port access transumbilical laparoscopic-assisted surgery were enrolled. The procedure was performed using the method of exteriorization and extracorporeal surgery of adnexal tumors outside the abdominal cavity under laparoscopic guidance with preservation of as much ovarian tissue as possible. In each case, a homemade single-port device was inserted into the abdomen through a 2-cm umbilical incision. The clinical characteristics and operative outcomes of these patients were reviewed.

Twenty of 22 cases were completed successfully. The one failed case required an additional trocar for adequate adhesiolysis, and the other case needed intraperitoneal drainage. The median operating time was 50 minutes (range, 35 to 120), and the estimated blood loss was 38mL (range, 10 to 300). Cyst rupture occurred in 2 cases, but there were no major postoperative complications.

Single-port access transumbilical laparoscopic-assisted surgery for benign and relatively large adnexal tumors is feasible and could be an alternative to convention open laparotomy or laparoscopic surgery.