What is the recommended technique for a salpingectomy?

Salpingectomy Surgical Technique

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

Surgical Approach Selection

The laparoscopic technique should be the standard approach for salpingectomy across most clinical contexts. 1 This recommendation is supported by the American College of Surgeons and provides superior visualization of the entire pelvic anatomy, allowing comprehensive assessment of both adnexa. 1

Key Technical Principles

• Complete removal of the fallopian tube including the proximal isthmus but not the interstitial portion is essential. 2
• Preservation of ovarian blood supply is critical—care must be taken not to damage the vascular supply to the ovary during the procedure. 2
• Bipolar diathermy forceps and laparoscopic scissors are the standard instruments for performing laparoscopic salpingectomy. 3

Context-Specific Considerations

For Endometrial Cancer Staging

When salpingectomy is performed as part of comprehensive staging for endometrial cancer, bilateral salpingo-oophorectomy should accompany total hysterectomy. 4, 1 The minimally invasive approach is recommended for low- and intermediate-risk endometrial cancer and can be considered for high-risk disease. 1

In cases where ovarian preservation is considered (patients younger than 45 years with grade 1 endometrioid endometrial cancer, myometrial invasion <50%, and no obvious ovarian or extra-uterine disease), salpingectomy is still recommended even when preserving the ovaries. 4

For BRCA Mutation Carriers

In patients with BRCA mutations undergoing risk-reducing bilateral salpingo-oophorectomy, the specimen must be processed using the SEE-FIM protocol (Sectioning and Extensively Examining the FIMbriated End), as recommended by the National Comprehensive Cancer Network. 1 This specialized pathologic examination is critical for detecting occult tubal malignancies.

For Ectopic Pregnancy

Laparoscopic salpingectomy is appropriate when one or more of the following criteria are met: 3

• Ruptured tube surgically unsuitable for conservation
• No interest in future fertility
• Previous tubal surgery on the affected tube
• Previous ectopic pregnancy on the same side treated expectantly

Clinical Outcomes

The laparoscopic approach demonstrates comparable reproductive outcomes to laparotomy, with intrauterine pregnancy rates of 64% versus 78% and repeat ectopic pregnancy rates of 6% versus 12%, respectively (differences not statistically significant). 3 The laparoscopic technique can be performed safely with low complication rates. 3

Common Pitfalls to Avoid

• Avoid damaging ovarian vasculature—the ovarian blood supply runs close to the fallopian tube and must be carefully preserved. 2
• Do not remove the interstitial portion of the tube during standard salpingectomy, as this increases surgical complexity and bleeding risk without clear benefit. 2
• If bleeding occurs that fails to respond to cauterization, conversion to laparotomy should be performed without hesitation. 5
• Ensure adequate surgical skills before attempting laparoscopic salpingectomy—any gynecologist who performs laparoscopic tubal sterilization by electrocautery has the necessary equipment and baseline skills for this procedure. 6