Page 35 - WJOLS - World Journal of Laparoscopic Surgery

Laparoscopic Conservative Treatment and Laparoscopic Salpingotomy

Fig. 6: The salpingostomy is performed at the proximal part of the Fig. 7: The robust, large suction device permits removal of the
hematosalpinx (Donnez J, et al. Atlas of Operative Laparoscopy and trophoblast through gentle and progressive traction (Donnez J, et al.
Hysteroscopy. Informa; 2007) Atlas of Operative Laparoscopy and Hysteroscopy. Informa; 2007)

Fig. 8: A repeat suction is performed (Donnez J, et al. Atlas of Operative Fig. 9: This minimal bleeding does not require further hemostasis and
Laparoscopy and Hysteroscopy. Informa; 2007) coagulation. The abdominal cavity must simply be washed (Donnez J,
et al. Atlas of Operative Laparoscopy and Hysteroscopy. Informa; 2007)
For women who have completed childbearing, bilateral
salpingectomy may be performed as permanent sterilization. The tubo-ovarian or utero-ovarian vessels, thus sparing the accessory
availability and high intrauterine pregnancy rate of IVF have also blood supply to the ovary.
decreased the need to preserve diseased fallopian tubes, including There is no difference in the direction of the salpingectomy:
tubes with an ectopic pregnancy. However, many women do not it can be carried out from the isthmus to the infundibulopelvic
have access to IVF for financial, geographic, or ethical reasons. An ligament or vice versa . Extraction of the tubes from the abdominal
additional potential benefit of salpingectomy rather than another cavity must be done in an endobag or through a culdotomy, rather
sterilization method is a decrease in the risk of tubal neoplasia with than pulling the tube through a trocar incision.
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spread to the ovary.
Salpingectomy appears to be associated with a reduced risk of
ovarian cancer, and some data suggest that the tube is the site of conclusIon
origin for some high-grade serous carcinomas that were presumed Ectopic pregnancy remains the leading cause of death in the first
77–80
to be ovarian. However, further study is needed, and unilateral trimester of pregnancy. Today, TVUS examination facilitates early
salpingectomy has not been investigated. detection of most ectopic pregnancies. Whether a laparoscopic
Electrosurgery was applied for salpingectomy by bipolar or salpingostomy should be done or a salpingectomy is still a matter
even monopolar coagulation. No data support a difference in the of debate. The choice of salpingostomy or salpingectomy relies
use of any of these technologies, even though bipolar cautery upon many factors and includes shared decision-making between
is generally considered to be less dangerous. The mesosalpinx the surgeon and patient.
and the blood vessels coursing through can be desiccated with The effect of different management strategies on subsequent
bipolar electrosurgery. It is rarely necessary to desiccate either the fertility after tubal ectopic pregnancy is still controversial.

World Journal of Laparoscopic Surgery, Volume 11 Issue 3 (September–December 2018) 143