Is a bilateral salpingectomy (tubal ligation) possible in a young female patient using a two-incision laparoscopic approach without a navel incision?

Bilateral Salpingectomy Using Two-Incision Approach Without Navel Incision

Yes, a bilateral salpingectomy is possible in a 20-year-old, 115lb female patient using a two-incision surgical approach without a navel incision. This approach is technically feasible and has been documented in the medical literature.

Surgical Approach Options

• Bilateral salpingectomy can be performed through various minimally invasive approaches, including traditional multi-port laparoscopy (typically 3-4 ports), single-port techniques, or two-port techniques 1
• While three or more surgical ports are commonly used for bilateral salpingectomy procedures (used in 100% of cases in one study), modified approaches with fewer ports are technically feasible 1
• A "one-trocar" technique has been described for salpingectomy using only an umbilical operative laparoscope and a percutaneous suture to manipulate the fallopian tube, demonstrating that reduced-port approaches are viable 2

Technical Considerations for Two-Incision Approach

• The two-incision approach would typically involve:
  • One incision for the laparoscope (placed in a non-umbilical location)
  • One incision for the operative instruments 1, 2
• Key anatomical considerations include:
  • Proper visualization of the fallopian tubes and their blood supply
  • Identification and preservation of the ureters and major blood vessels 3
• The procedure would involve careful dissection and removal of both fallopian tubes while preserving the ovaries 3

Patient-Specific Considerations

• The patient's low body weight (115lb) and young age (20 years) are favorable factors for a minimally invasive approach with reduced port numbers 3
• Preservation of ovarian function is particularly important in this young patient to prevent premature menopause 4, 3
• The procedure would involve bilateral salpingectomy with preservation of the uterus and ovaries 3

Potential Benefits of This Approach

• Reduced number of incisions compared to traditional laparoscopy (which typically uses 3-4 ports) 1
• Avoidance of umbilical incision, which may be preferred for cosmetic reasons 5
• Bilateral salpingectomy provides superior contraceptive efficacy compared to tubal occlusion methods 1, 6
• Potential reduction in ovarian cancer risk compared to traditional tubal ligation 6, 7

Potential Limitations and Risks

• Two-incision approach may increase technical difficulty compared to traditional multi-port laparoscopy 1
• Limited triangulation of instruments may make the procedure more challenging 5
• Procedure time may be longer compared to traditional approaches 1
• As with any surgical procedure, risks include bleeding, infection, and damage to surrounding structures 3

Conclusion

A bilateral salpingectomy using a two-incision approach without a navel incision is technically feasible in a 20-year-old, 115lb female patient. This approach offers the benefits of permanent contraception with reduced incision numbers while preserving ovarian function.