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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 (u003e800 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u003e2000 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.

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