Tips and Tricks for Performing Salpingectomy at the Time of Laparoscopic Hysterectomy

Abstract

Study objective: To demonstrate various techniques to perform salpingectomy efficiently at the time of laparoscopic hysterectomy.

Design: Step-by-step explanation of the techniques by video with narration (educational video) (Canadian Task Force Classification III).

Intervention: Salpingectomy at the time of laparoscopic hysterectomy.

Measurements and main results: Ovarian cancer is the deadliest gynecologic malignancy and has no effective screening strategies for average-risk women. After recognizing that the origin site for pelvic serous carcinomas may be the fallopian tube, the Society of Gynecologic Oncology published a practice statement in November 2013 addressing the role of salpingectomy at the time of hysterectomy or other pelvic surgery in average-risk women. (https://www.sgo.org/clinical-practice/guidelines/sgo-clinical-practice-statement-salpingectomy-for-ovarian-cancer-prevention). They now recommend that these women consider opportunistic salpingectomy to reduce their risk of fallopian tube and ovarian cancers. Various techniques allow the surgeon to complete the salpingectomy in a highly efficient manner.

Conclusion: Salpingectomy at the time of laparoscopic hysterectomy or other pelvic surgery should be considered in women at average risk of ovarian cancer. Salpingectomy can be performed either before or after control of the uterine blood supply. The surgical approach must also consider the coexisting pelvic pathology. Efficient dissection occurs if the surgeon maximizes exposure to the fallopian tube, optimizes presentation of the tissue to the working instrument, and provides gentle yet constant traction with accompanying countertraction. The fallopian tube specimen should be removed immediately to prevent its loss in the pelvis.