What are the steps involved in a laparoscopic salpingectomy (surgical removal of the fallopian tube)?

From the Guidelines

A laparoscopic salpingectomy is a minimally invasive surgical procedure to remove one or both fallopian tubes, and the steps involved include creating a small incision for primary port insertion, inserting the laparoscope, and systematically coagulating and cutting the mesosalpinx to free the fallopian tube. The procedure begins with the patient under general anesthesia in the dorsal lithotomy position with slight Trendelenburg tilt 1. After sterile preparation and draping, the surgeon creates a small incision (10-12mm) at the umbilicus for the primary port insertion using either an open (Hasson) technique or closed (Veress needle) approach. Carbon dioxide gas is used to create pneumoperitoneum with pressure maintained at 12-15 mmHg, as seen in the LAP2 study which compared laparoscopy with laparotomy for comprehensive surgical staging and management of stage I–IIA uterine cancer 1. The laparoscope is inserted through this port for visualization. Two to three additional 5mm ports are placed in the lower abdomen, typically one in each lower quadrant and sometimes a third suprapubically. The patient is then tilted into steep Trendelenburg position to allow bowel to fall away from the pelvis. The surgeon identifies the fallopian tube and grasps it with atraumatic forceps. The mesosalpinx (the mesentery supporting the tube) is then systematically coagulated and cut using bipolar electrocautery, ultrasonic energy devices, or vessel sealing instruments, with a significant advantage of laparoscopy over laparotomy in terms of postoperative complications (RR 0.71; 95% CI 0.63–0.79) as found in a meta-analysis by Zullo et al. 1. The surgeon works methodically from the fimbrial end toward the cornual portion, ensuring complete hemostasis. Special attention is paid to the proximity of the ureter and to preserving ovarian blood supply if the ovary is being retained. Once the tube is completely freed, it is removed through one of the ports, typically using a specimen retrieval bag. The pelvis is irrigated and inspected for hemostasis. The pneumoperitoneum is released, ports are removed, and incisions are closed with absorbable sutures. Patients typically go home the same day and can resume normal activities within 1-2 weeks, with pelvic rest recommended for 2 weeks postoperatively, as laparoscopy was associated with significantly fewer moderate-to-severe postoperative adverse events (14% versus 21%) and a lower frequency of hospitalisations of more than 2 days (52% versus 94%) than laparotomy 1.

Some key points to consider during the procedure include:

• The use of carbon dioxide gas to create pneumoperitoneum with pressure maintained at 12-15 mmHg
• The placement of two to three additional 5mm ports in the lower abdomen
• The systematic coagulation and cutting of the mesosalpinx using bipolar electrocautery, ultrasonic energy devices, or vessel sealing instruments
• The importance of preserving ovarian blood supply if the ovary is being retained
• The use of a specimen retrieval bag to remove the fallopian tube.

Overall, the laparoscopic salpingectomy is a safe and effective procedure with fewer postoperative complications and shorter hospital stay compared to laparotomy, as supported by the LAP2 study and the meta-analysis by Zullo et al. 1.

From the Research

Steps Involved in Laparoscopic Salpingectomy

The steps involved in a laparoscopic salpingectomy, or the surgical removal of the fallopian tube, can be outlined as follows:

• The procedure is typically performed using a multiple abdominal puncture approach 2
• Electrosurgical coagulation and laser transection of the isthmus, mesosalpinx, and tubo-ovarian ligaments are used to accomplish salpingectomy 2
• The fallopian tubes are removed from the pelvic cavity through one of the suprapubic punctures 2
• Care must be taken not to damage the vascular supply of the ovary during the procedure 3
• The technique of salpingectomy consists of complete removal of the fallopian tube, including the proximal isthmus but not the interstitial portion 3

Considerations and Variations

The decision to perform a laparoscopic salpingectomy may depend on various factors, including:

• The patient's vital signs and desire for future fertility 3, 4
• The patient's age, previous history of infertility, and tubal status 3
• The availability of and accessibility to assisted reproductive technology 3
• The presence of complications such as bleeding, which may require conversion to an open procedure (laparotomy) 5, 6