Differentiating Right and Left Fallopian Tubes During Grossing
The right and left fallopian tubes cannot be reliably differentiated from each other based on their gross anatomical features alone during pathological examination—proper laterality identification depends entirely on accurate surgical labeling and specimen orientation by the surgical team at the time of removal.
Critical Dependence on Surgical Labeling
The pathologist must rely on the surgeon's specimen labeling to identify right versus left fallopian tubes, as there are no consistent gross morphological features that distinguish laterality 1.
Proper communication between surgical and pathology teams is essential, with specimens clearly labeled at the time of removal to prevent laterality errors 1.
Anatomical Considerations That Do NOT Reliably Indicate Laterality
While some anatomical studies have documented minor differences, these are not clinically useful for grossing:
Length variations are inconsistent and overlapping: Research has shown the right fallopian tube may average slightly longer (9.19 cm) than the left (8.82 cm) in some populations, but this difference is too variable and small to be diagnostically useful 2.
Anatomical variations occur: Accessory fallopian tubes, duplications, and other müllerian duct anomalies can occur unilaterally (more commonly on the right side in reported cases), but these are rare and cannot be used as reliable laterality markers 3, 4.
Kinking patterns are unreliable: While increased kinking has been observed more frequently in certain age groups, this does not correlate with laterality 2.
Practical Grossing Protocol
Verify specimen labeling immediately upon receipt: Confirm that the surgical team has clearly marked right versus left before beginning dissection 1.
Document the labeled laterality in your gross description: State explicitly which tube is identified as right or left based on the surgical label 1.
Process both tubes identically using SEE-FIM protocol: Both fallopian tubes should be entirely submitted using the Sectioning and Extensively Examining the FIMbriated End protocol, particularly in cases of high-grade serous carcinoma where tubal involvement is unilateral in the majority of cases 1.
Common Pitfalls to Avoid
Never assume laterality based on specimen appearance alone—this will lead to errors in staging and clinical management 1.
Do not rely on associated ovarian tissue for orientation unless the specimen is received intact with clear anatomical landmarks and surgical labeling 1.
If laterality is uncertain or unlabeled, document this clearly in your report and communicate with the surgical team before finalizing the pathology report, as accurate laterality is critical for staging (particularly for early-stage disease where unilateral versus bilateral involvement changes FIGO staging) 1.