What is the recommended technique for performing a salpingectomy?

Salpingectomy Surgical Technique

The procedure involves systematic isolation and removal of the fallopian tube from its fimbrial end to the uterine cornu, with meticulous preservation of ovarian blood supply through careful dissection of the mesosalpinx. 1

Surgical Approach

Minimally invasive laparoscopic surgery is the preferred approach for salpingectomy, offering reduced morbidity, shorter hospitalization, and faster recovery compared to laparotomy. 1

• Multiple abdominal punctures are used to establish adequate visualization and instrument access 2
• The laparoscopic approach provides superior visualization of the entire pelvic anatomy and allows for comprehensive assessment of both adnexa 3

Step-by-Step Technique

1. Initial Assessment and Mobilization

• Systematically inspect the fallopian tube from fimbrial end to cornual insertion 4
• Assess the mesosalpinx and identify the ovarian blood supply running through the infundibulopelvic ligament 4
• Mobilize any adhesions to achieve adequate exposure 2

2. Mesosalpinx Dissection

• The critical technical point is preserving the ovarian vascular supply while completely removing the tube. 4
• Begin dissection at the fimbrial end, working medially toward the uterine cornu 2
• Create a window in the mesosalpinx immediately adjacent to the fallopian tube, staying close to the tubal wall to avoid the ovarian vessels 4
• Use electrosurgical coagulation or laser energy to sequentially coagulate and transect the mesosalpinx in small bites 2

3. Cornual Transection

• Complete removal includes the entire fallopian tube including the proximal isthmus, but NOT the interstitial portion. 4
• Coagulate and transect the tube at the uterotubal junction 2
• Ensure hemostasis at the cornual stump with adequate coagulation 5

4. Tubo-Ovarian Ligament Division

• Identify and coagulate the tubo-ovarian ligament connecting the fimbrial end to the ovary 2
• Transect this ligament carefully to avoid ovarian injury 2

5. Specimen Removal

• Remove the fallopian tube through one of the suprapubic port sites 2
• If the specimen is too large, it may be placed in an endoscopic bag for morcellation or removed through a slightly enlarged port 6

Critical Technical Considerations

Vascular Management

• The primary pitfall is inadvertent injury to the ovarian blood supply, which runs through the infundibulopelvic ligament lateral to the tube. 4
• Maintain dissection immediately adjacent to the fallopian tube throughout the procedure 4
• Achieve meticulous hemostasis before completing the procedure 5

Handling Complications

• If bleeding occurs that fails to respond to cauterization, be prepared to convert to laparotomy 5
• The procedure should only be performed by surgeons comfortable with basic laparoscopic surgical principles 5, 6

Special Contexts

Risk-Reducing Surgery

• In BRCA mutation carriers undergoing risk-reducing bilateral salpingo-oophorectomy, the specimen should be processed using the SEE-FIM (Sectioning and Extensively Examining the FIMbriated End) protocol 1
• This involves serial sectioning of the fimbrial end at 2-3mm intervals to detect occult malignancy 1

Endometrial Cancer Staging

• When performed as part of comprehensive staging for endometrial cancer, bilateral salpingo-oophorectomy should accompany hysterectomy 1
• The minimally invasive approach is recommended for low- and intermediate-risk endometrial cancer and can be considered for high-risk disease 1

Postoperative Outcomes

• Mean operative time for laparoscopic salpingectomy is approximately 22 minutes 2
• Mean hospitalization duration is 7.4 hours, with most patients managed as outpatients 2
• The procedure is associated with decreased surgical pain, lower cost, shorter convalescence, and minimal scarring compared to laparotomy 5, 6