This Video demonstrates right sided Salpingo Oophorectomy with Appendectomy and Extraction Through Colpotomy. Prophylactic removal of the appendix during a benign gynecologic procedure is known as an elective incidental laparoscopic appendectomy. Incidental appendectomy at the time of cesarean delivery was reported initially in 1959. Subsequent studies of removal of a normal-appearing appendix at the time of gynecologic surgery have met with considerable debate. Proponents argue that the removal of the appendix at the time of abdominal hysterectomy does not increase operative time or postoperative morbidity. More important, it does prevent future appendicitis. Advantages of incidental appendectomy include technical ease, low patient morbidity and mortality, and significant diagnostic and protective value. It also prevents conflicting diagnoses, especially in patients who have chronic pelvic pain, a ruptured ovarian cyst, or endometriosis. Other patients likely to benefit from elective incidental appendectomy are those who are undergoing abdominal radiation or chemotherapy, women unable to communicate health complaints, and those who are planning to undergo complex abdominal or pelvic procedures that are likely to cause extensive adhesions.

Salpingo-oophorectomy, the surgical removal of the fallopian tube and ovary, is a common gynecologic procedure performed for various benign and malignant conditions. In select cases, combining this procedure with an appendectomy may be indicated, such as in patients with suspected appendiceal pathology, endometriosis, or risk of ovarian and appendiceal neoplasms. Extracting the specimen through colpotomy, a minimally invasive transvaginal approach, reduces abdominal wall trauma and promotes faster recovery.

Indications
The combined procedure may be indicated in:

• Ovarian cysts or tumors requiring oophorectomy

• Fallopian tube pathology (hydrosalpinx, tubal neoplasms)

• Endometriosis involving the ovary and appendix

• Suspicious appendiceal lesions

• Prophylactic removal in high-risk patients (BRCA mutation carriers)

Surgical Technique

1. Preoperative Preparation

   • Complete clinical evaluation, imaging (ultrasound, MRI, or CT)

   • Routine preoperative labs and anesthesia assessment

   • Informed consent explaining both laparoscopic and colpotomy procedures

2. Patient Positioning

   • Lithotomy position for optimal vaginal access

   • Trendelenburg position to move bowel away from the pelvis

3. Laparoscopic Port Placement

   • Standard 3–4 port technique

   • Umbilical port for camera

   • Accessory ports in lower quadrants for instrumentation

4. Salpingo-Oophorectomy

   • Identification and careful dissection of the ovary and fallopian tube

   • Control of the ovarian vessels using energy devices or clips

   • Complete excision of the ovary and tube

5. Appendectomy

   • Mobilization of the appendix

   • Ligation of mesoappendix and appendiceal base

   • Transection using staplers or energy devices

6. Specimen Extraction via Colpotomy

   • Posterior colpotomy incision is made in the posterior fornix

   • Specimens are placed in a retrieval bag and extracted transvaginally

   • Colpotomy incision closed with absorbable sutures

Advantages of Colpotomy Extraction

• Avoids enlargement of abdominal incisions

• Minimizes risk of port-site hernias

• Reduces postoperative pain

• Provides excellent cosmetic outcomes

• Faster recovery and shorter hospital stay

Postoperative Care

• Early ambulation to prevent venous thromboembolism

• Pain management with NSAIDs or mild opioids

• Monitoring for vaginal bleeding or infection

• Follow-up imaging or pathology review as indicated

Complications
Though minimally invasive, potential complications include:

• Bleeding or hematoma formation

• Vaginal cuff infection or dehiscence

• Injury to surrounding organs (bladder, bowel, ureter)

• Adhesion formation

Conclusion
Salpingo-oophorectomy combined with appendectomy and transvaginal extraction through colpotomy represents an advanced, minimally invasive technique that maximizes patient safety, reduces surgical trauma, and enhances recovery. With proper patient selection and meticulous surgical technique, this approach can be an effective alternative to conventional laparotomy for appropriate cases.