Hysteroscopic Tubal Flushing Combined With Laparoscopic Milking for Ectopic Pregnancy Removal: A Case Report and Literature Review

Abstract

We present a novel approach combining hysteroscopic flushing and laparoscopic milking for tubal ectopic pregnancy (EP) removal while preserving fallopian tubes. Postoperative beta-human chorionic gonadotropin (β-hCG) suspected remnant EP, necessitating methotrexate. Three-month follow-up confirmed bilateral tubal patency. This technique offers a tube-preserving treatment for EP; however, β-hCG monitoring is crucial.

Keywords: case report; ectopic pregnancy; hydrostatic pressure; hysteroscopy; laparoscopy; tubal pregnancy.

FIGURE 1

Schematic representation of the surgical procedure employed for the removal of an EP mass located in the ampullary segment of the fallopian tube. (a) Insertion of the hysteroscope into the uterine cavity. (b) Application of hydrostatic pressure using normal saline, delivered via the hysteroscope, to detach the pregnancy mass from its implantation site in the fallopian tube. (c) Laparoscopic milking to guide the detached pregnancy mass toward the fimbrial end of the fallopian tube. (d) Expulsion of the pregnancy mass through the fimbrial end, followed by its retrieval using a laparoscopic endobag.

FIGURE 2

The laparoscopic view of the procedure. (A) High‐pressure normal saline infusion via the hysteroscope detached the pregnancy mass from the ampullary segment of the left fallopian tube. (B, C, D, and E) Laparoscopic milking of the fallopian tube guided the detached pregnancy mass toward the fimbrial end. (F) Following the milking process and release of pressure from the fallopian tube, the remaining pregnancy products, along with stored normal saline from the hysteroscope, were rapidly expelled through the fimbrial end, which were subsequently collected using a laparoscopic endobag.

FIGURE 3

Three‐month follow‐up hysterosalpingography showing a normal uterine cavity and bilateral fallopian tube patency with appropriate caliber and peristalsis.