Laparoscopic temporary uterine artery occlusion combined with en bloc lesion resection for type III cesarean scar pregnancy: surgical technique.

This article presents a refined laparoscopic surgical technique for the management of type IIIb cesarean scar pregnancy (CSP), as classified by Ban et al.'s 2023 criteria [residual myometrial thickness <3 mm, maximum sac diameter (MSD) ≥3 cm, bladder protrusion], in a 35-year-old female with vaginal bleeding and a history of two cesarean sections. The core protocol integrates temporary bilateral uterine artery occlusion (simple ligation of the main trunk with No. 1 absorbable Vicryl suture at 2 cm from the uterine wall) immediately before resection, adhesiolysis, en bloc excision of the ectopic mass with a 0.3 cm safe margin, and multilayer anatomical uterine repair. This technique addresses the key clinical challenge of massive intraoperative bleeding in highly vascular type IIIb CSP, with innovations in precise timing of occlusion and reversible minimally invasive ligation. Perioperative outcomes demonstrated excellent hemostasis (total blood loss 100 mL), complete lesion removal confirmed by frozen section, and intact uterine anatomy post-surgery. The study emphasizes the technique's value in hemorrhage control, anatomical restoration, and fertility preservation for patients with large type IIIb CSP (66 mm in this case). We provide a detailed step-by-step surgical guide, clarify patient selection criteria and contraindications, and discuss the technique's advantages, limitations, and potential to revise the standard of care for type III CSP. Postoperative 18-month follow-up showed successful natural conception and uncomplicated second-trimester pregnancy, validating its long-term fertility benefits.