Although heterotopic pregnancy (HP) is a very rare condition in the natural ovulation cycle with an incidence of approximately 1/30,000 cases, the incidence has been increasing to up to 1/100 cases by worldwide adoption of assisted reproductive therapy. Risk factors include multiple embryo transfer and the use of oocyte induction. Laparoscopic surgery (LS) has been reported as an effective diagnostic and therapeutic option, and almost 60-80% of pregnant women could deliver their live babies after LS.

　In this report, we present the patient characteristics, operative results, and pregnancy outcomes of four HP cases treated by LS in our affiliated institutions from January 2015 to March 2020. Of the four cases, two suspected cases at preoperative examinations could be successfully diagnosed by LS.

　Three cases had an ectopic mass at the fallopian tube and underwent salpingectomy. The other case was found to be an ectopic ovarian pregnancy and underwent partial ovariectomy. No major perioperative complication occurred in all cases. Two patients delivered healthy babies at term, while one resulted in spontaneous abortion before LS, and the other one underwent abortion after 11 weeks of LS. In conclusion, laparoscopic surgery is a reasonable diagnostic and therapeutic option for HP. We need to adequately explain to patients the risks and benefits of LS, preoperative complications, and expected pregnancy outcomes before the surgery.