Laparoscopic Salpingectomy

Overview

A salpingectomy is a surgical procedure that removes one or both of a woman's fallopian tubes. It is used to treat fallopian tube disorders and ectopic pregnancies, as well as a prophylactic step for women who are at a higher risk of getting ovarian cancer. To shorten recovery time, a salpingectomy can be done laparoscopically.

Laparoscopic salpingectomy may be performed if you have a blocked or ruptured tube, a fertilized egg in a fallopian tube instead of your womb, womb tissue growing on the tubes (endometriosis), infection, cancer of the fallopian tube (rare), and some women may have this surgery to lower their risk of ovarian tumor. 

 

What are Different Type of Salpingectomy?

The surgical removal of one or both fallopian tubes is termed as salpingectomy. It can be combined with other procedures based on different issues of the patient. Hence, the types of the salpingectomy are discussed as follows:

1. Unilateral salpingectomy: When only one fallopian tube from either side is removed, it is called unilateral salpingectomy.
2. Bilateral salpingectomy: This is when both fallopian tubes are removed. You wouldn't be able to get pregnant naturally, but IVF (In Vitro Fertilization) is an option if you wish to become pregnant and still have a uterus.
3. Partial salpingectomy: When only a part of the fallopian tube is removed, then it is termed as a partial salpingectomy.
4. Total salpingectomy: When the entire fallopian tube is removed, then it is termed as total salpingectomy.
5. Salpingo-oophorectomy: When the ovaries are also removed along with the fallopian tubes, then it is termed as a salpingo-oophorectomy.

 

What Conditions Can a Salpingectomy Treat?

A salpingectomy or salpingostomy can be performed to treat several serious gynecological conditions.

1. Endometriosis: It is a somewhat common disorder that can produce intensely painful periods and affects more than 10% of American women throughout their reproductive years. The majority of the patients are between the ages of 30 and 40. Endometrial-like tissue behaves similarly to endometrial tissue, thickening, breaking down, and bleeding with each menstrual cycle. However, because this tissue cannot leave your body, it remains imprisoned. Endometriomas can occur when endometriosis affects the ovaries. Surrounding tissue can become inflamed, leading to the formation of scar tissue and adhesions – bands of fibrous tissue that can cause pelvic tissues and organs to stick together.
2. Infection due to sexually transmitted or other diseases. Sexually transmitted diseases (STDs) or sexually transmitted infections (STIs) are most commonly spread through sexual contact. Bacteria, viruses, and parasites that cause sexually transmitted illnesses can spread from person to person through blood, sperm, vaginal fluid, and other body fluids. Non-sexual transmission of these illnesses can occur, for example, from mothers to their infants during pregnancy or childbirth, or through blood transfusions or sharing needles.
3. Tubal adhesions.  Adhesions, like scar tissue, are bands of tissue that can grow between the fallopian tubes and ovaries, causing them to stay together. Adhesions can inhibit ovulation and make it hard for tubes to transport sperm or embryos. Patients who have had previous pelvic infections or who have had stomach disorders such as appendicitis or ovarian cyst surgery are at a higher risk for tubal complications. Many patients with pelvic adhesions, tubal obstruction, or even hydrosalpinges may be unaware of a past infection since the symptoms of some bacteria can be quite minor.
4. Ectopic pregnancy. An ectopic pregnancy is a potentially fatal disorder in which a fertilized egg implants some place other than the uterus. This usually happens inside a fallopian tube. This form of "pregnancy" is not viable and must be terminated as soon as possible. The most dangerous aspect of an ectopic pregnancy is the zygote's development (fertilized egg). When the zygote becomes too large, it ruptures the Fallopian tube, resulting in serious internal bleeding.
5. Hydrosalpinx. A type of tubal factor infertility is hydrosalpinx. A hydrosalpinx is a swelling of the fallopian tube with fluid. It has the potential to induce infertility and ectopic pregnancy. It usually happens at the fimbrial end of the tube near to the ovary, but it can also happen at the opposite end of the tube where it connects to the uterus. If you have a hydrosalpinx and are attempting to get pregnant, you should consult with a fertility doctor.
6. Fallopian tube cancer. Though fallopian tube cancer is rare, it’s more common in women who carry the BRCA gene mutation. Almost half of women with BRCA gene mutations have fallopian tube lesions. A prophylactic salpingectomy can be performed on women who are at a high risk of developing ovarian cancer.
7. Infertility. Although it may appear counterintuitive, removing one or both Fallopian tubes can typically result in better reproductive outcomes than restoring the tubes. A salpingectomy has been proven to improve the odds of implantation during IVF in some infertile women. Furthermore, if your Fallopian tubes are damaged, you may be at risk for ectopic pregnancy or adhesions.
8. Blocked fallopian tube.
9. Scarring or blockage due to previous tubal surgery.
10. Ruptured fallopian tube.

 

How is a Salpingectomy Different Than an Oophorectomy or a Hysterectomy?

An oophorectomy is the surgical removal of one or both of your ovaries, whereas a salpingectomy is the surgical removal of one or both of your fallopian tubes. Your healthcare professional may do both treatments at the same time, depending on your circumstances. Unilateral salpingo-oophorectomy is the removal of one ovary and one fallopian tube. A bilateral salpingo-oophorectomy is when both fallopian tubes and both ovaries are removed at the same time.

The surgical removal of your uterus is known as a hysterectomy. It can be used to treat cervical or uterine cancer, fibroids, uterine prolapse, severe endometriosis, and other uterine disorders. As part of her therapy, a woman may undergo both a hysterectomy and a salpingectomy.

 

Laparoscopic Vs Open Salpingectomy

There are two types of salpingectomy surgical methods:

1. Laparoscopic salpingectomy. A laparoscope is a narrow tool with a light and camera at the end that is used in minimally invasive surgery. It is implanted by a tiny incision in the abdomen. The surgeon will then inflate your belly with gas to observe your uterus and fallopian tubes in more detail. Finally, surgical instruments are placed into your belly through additional tiny incisions to remove the fallopian tubes. Your surgeon will seal the wounds with stitches or medical glue after removing excess blood and fluid.
2. Open abdominal salpingectomy. Across your belly, a huge incision is created (called a laparotomy). Through this incision, your surgeon will be able to access your fallopian tubes. After removing the fallopian tubes, your surgeon will stitch or staple the wound closed A laparoscopic approach is preferred because it's less invasive with a shorter recovery time and lower risk of complications. But an open approach may be necessary depending on other factors.

 

Advantages & Disadvantages of Laparoscopic Surgery

Advantages:

• Reduced blood loss.
• Less adhesion formation.
• No large incisions.
• Rapid postoperative recovery.
• Quicker resumption of day to day activity.
• Minimal abdominal scars.
• Shorter hospital stay.
• Reduced concomitant cost.
• Less postoperative pain.
• Less use of postoperative analgesia.
• Increased patient's satisfaction.

 

Disadvantages: 

• Risk of iatrogenic complications.
• Surgeons need specialized training and experience.
• High initial expenditure.
• Equipment and instruments are sophisticated.
• Long learning curve.
• Operation time might be longer.

 

What are the Pre-operative Tests Done Before Laparoscopic Salpingectomy?

Prior to salpingectomy, tests are done to diagnose and confirm the underlying disease condition. These include:

1. Abdominal and Pelvic Ultrasound: An abdominal ultrasound is frequently used to determine the underlying reason. A gel is put to the abdomen and a probe is passed over it during the ultrasound. Images are acquired and shown on a screen. The technique is absolutely painless and is performed as an outpatient surgery.
2. Hysterosalpingogram: A syringe is used to infuse contrast material (also known as a dye) into the uterus via the vaginal channel during this procedure. The contrast enters the abdomen via the uterus and the fallopian tube, which may be seen with imaging testing. If there is a blockage in the fallopian tube, the contrast cannot get through and is shown as a narrow segment on the x-ray.
3. Diagnostic Laparoscopy: Laparoscopy is sometimes used to directly visualize the fallopian tubes and other structures of the abdomen and diagnose the problem
4. Routine Tests: Routine tests which are done before any surgery include:
   • Blood tests like hemoglobin levels, blood group, electrolytes and kidney function tests.
   • Routine urine test.
   • ECG to study the electrical activity of the heart before anesthesia to make sure that the patient is fit prior to the surgery.
   • Chest x-ray to rule out infection in the chest before anesthesia.

In older group of patients, detailed assessment of the heart may be required to make sure that they are fit for surgery and undergo an anesthesia.

 

Before, During & After Laparoscopic Salpingectomy Procedure

1. Type of Anesthesia - Salpingectomy is performed under general anesthesia and, in rare cases, regional anesthesia by injecting a numbing agent into the back to numb the spinal nerves. You will be unconscious during the procedure if you are under general anesthesia and will be unaware of what is going on.
2. Pre-operative Check-up - Routine tests as indicated above are ordered a few days before the surgery. Admission is usually required a day before the surgery.
3. Day before Surgery - An enema is occasionally given the day before surgery, in the afternoon or evening. Some units may opt to administer laxative pills the night before.
4. Fasting before Surgery - Overnight fasting is essential, and intravenous fluid may be required on occasion to keep you hydrated. Sedation is sometimes necessary for a decent night's sleep prior to surgery.
5. Shift from the ward or room to the waiting area in the operating room - An hour or two before the surgery, you will be shifted to the operating room waiting area on a trolley.

 

Once the surgical room is ready, you will be shifted to the operating room.

1. Shift to the Operating Room - The environment in the operating room can be daunting at times, and a small amount of sedation can help you overcome your anxiety. You will be transferred from the trolley to the operation table. When you glance up, you will notice the operating light console and the anesthetic machine at the head end. Monitors for oxygen levels, ECG, and other vital metrics may also be included. The monitors may emit a continual beeping sound, which can be bothersome at times.
2. Anesthesia before Surgery - If you need general anesthesia, the anesthesiologist will administer drugs through an intravenous line and have your breath gases through a mask to put you to sleep. Once you've fallen asleep, a tube will be put into your mouth and windpipe to deliver anesthetic gases to help you sleep and keep you comfortable. An injection will be given into your lower spinal column if you are getting regional anesthesia.
3. The Salpingectomy Procedure - If you need to be sedated for laparoscopy, tiny incisions will be created to allow the laparoscope and surgical tools to pass through. For greater vision, the abdomen is insufflated with carbon dioxide during laparoscopy. Once the fallopian tube has been found, it is separated from the surrounding tissues while the bleeding is controlled. The tube is knotted at the uterine end and removed. In some circumstances, endoscopic staples, endocoagulation, cautery, or laser may be utilized instead of ligatures. The ovary and fallopian tube may also be removed. The ovaries are maintained in younger women who want to keep their ovarian function and fertility. In patients receiving bilateral salpingectomy, the treatment will be repeated on the other side. The incision is then closed.

 

After the procedure has been done, you will be transported to the recovery room: 

1. Waking up from General Anesthesia - After the procedure, you will be awakened and the tube into your windpipe will be removed. Before the tube is withdrawn, you will be requested to open your eyes. You will be sedated, and the anesthetist's speech may be weak. When the tube is removed, you may experience coughing and nausea. Rarely there may be a tube going into the stomach called a nasogastric or Ryle's tube to keep it empty. There will also be an intravenous line. You will remain on oxygen. Once fully awake, you will be shifted on the trolley and taken to the recovery room.
2. Recovery Room - In the recovery room, a nurse will monitor your vitals and observe you for an hour or two before shifting you to the room or a ward.
3. Post-operative Recovery - You will remain in the hospital for a few days following the procedure. A laparoscopic surgery ensures a shorter recovery time and therefore duration of admission. Light foods may be allowed following the surgery. Occasionally chest physiotherapy maybe started after 24 hours to prevent chest infection. If the salpingectomy has been done for a ruptured pregnancy, you may need to be in an Intensive Care Unit overnight. Blood transfusion may also be required.
4. DVT Prophylaxis - Early movement of your legs and some mobilization prevents DVT or deep vein thrombosis, where a clot is formed in the deep veins of the legs. The clot can travel up to the lungs and even be fatal. Other measures like small dose of heparin and special stockings may also be used.
5. Analgesia- Painkillers may be prescribed depending on the extent of the pain. A few shots of antibiotics maybe given intravenously to prevent infection.

 

Can I Get Pregnant After My Laparoscopic Salpingectomy?

It is determined by the sort of salpingectomy performed. If you undergo a unilateral salpingectomy (just one fallopian tube is removed), you will be able to conceive as long as the other fallopian tube is still functional. You will be unable to conceive naturally if both fallopian tubes are removed (bilateral salpingectomy).

You can have an IVF (In Vitro Fertilization) pregnancy if you've undergone a salpingectomy. IVF is a procedure in which your eggs are fertilized in a lab and then transferred into your uterus.

 

Is Laparoscopic Salpingectomy Risky?

There are risks to any type of surgery, including a bad reaction to anesthesia. Laparoscopy can take more time than open surgery, so you may be under anesthesia longer. Other risks of salpingectomy include:

• Infection (the risk of infection is lower with laparoscopy than with open surgery).
• Internal bleeding or bleeding at the surgical site.
• Hernia.
• Damage to blood vessels or nearby organs.

Although it takes a little longer, laparoscopic salpingectomy has been found to be a safe alternative to tubal occlusion. Because it’s more effective and may offer some protection from ovarian cancer, it’s an additional option for women seeking sterilization.

 

When Should I See My Doctor?

If you've had one or both of your fallopian tubes removed, you should watch for these signs:

• Swelling or redness at the incision.
• Leaking fluid or pus from the incision.
• Pelvic pain.
• Swelling or pain in your legs (a sign of blood clots).
• Fever or chills.
• Painful urination.

Contact your healthcare provider immediately if you experience these symptoms, as it could indicate complications from surgery.

 

Conclusion

The Fallopian tubes are two small tunnels that connect the uterus to the ovaries. The small finger-like fimbriae guide an egg from the ovaries into the Fallopian tubes during menstruation. The egg is subsequently transported into the uterus via the Fallopian tube. An egg can be fertilized by a sperm in the Fallopian tube, resulting in a pregnancy, or it can be shed along with the uterine lining during the woman's next period.

One fallopian tube (unilateral salpingectomy) or both may be surgically removed during salpingectomy surgery (bilateral salpingectomy). Your doctor may advise you to have your Fallopian tube(s) removed as a therapy for infertility or tubal illness, such as cancer or infection.

Removal of both Fallopian tubes makes natural conception impossible but other fertility options, such as in-vitro fertilization (IVF), may still be available. Some patients may be able to preserve their Fallopian tubes with alternative tubal surgery.