Vaginal Salpingectomy Techniques in the Presence of Ovarian Conservation.

STUDY OBJECTIVE: To demonstrate vaginal salpingectomy techniques in the presence of ovarian conservation. DESIGN: Technical video demonstrating 2 methods of Fallopian tube removal with illustrations (Canadian Task Force classification III). SETTING: The prevalence of salpingectomy at the time of hysterectomy has increased significantly since 1998 [1]. One reason for the increased rate of salpingectomy is the relationship of serous ovarian carcinomas to fimbrial serous tubal intraepithelial carcinomas [2]. A Swedish population-based study reported that salpingectomy is an effective measure to reduce ovarian cancer risk in the general population [3]. Prophylactic salpingectomy and delayed oophorectomy may be an acceptable alternative in some BRCA mutation carriers [4]. A retrospective cohort study of 425 vaginal hysterectomies showed that 88% of patients were able to successfully undergo concomitant salpingectomy [5]. Mayo Clinic Institutional Review Board approval was not required for this video article. INTERVENTION: Two methods of salpingectomy are demonstrated differing in the final disposition of the proximal Fallopian tube (segment). The 2 different methods are shown to increase clarity and understanding of the technique. CONCLUSION: Salpingectomy without concomitant removal of the ovaries at vaginal hysterectomy is a feasible and beneficial procedure.

Success and Complications of Salpingectomy at the Time of Vaginal Hysterectomy.

STUDY OBJECTIVES: To document the success rates and complications of salpingectomy performed at the time of vaginal hysterectomy to possibly reduce ovarian cancer rates. DESIGN: Retrospective cohort study (Canadian Task Force Classification II-2). SETTING: Community-based hospital with university affiliation in Calgary, Canada. INTERVENTION: All women undergoing hysterectomy for benign conditions were offered preferentially a vaginal approach with prophylactic salpingectomy. MEASUREMENTS AND MAIN RESULTS: During the study period (October 2011 to January 2014), a total of 425 vaginal hysterectomies were performed. The overall success rate of salpingectomy was 88%. Pelvic adhesions significantly predicted the ability to perform salpingectomies (odds ratio, 6.3; 95% confidence interval, 2.8-14.3; p < .001). Age also was predictive of outcomes (p = .007), with increasing age predicting decrease success. The overall postoperative complication rate was 15%, with 3.8% possibly attributable to salpingectomy (i.e., intrapelvic complications). No associated factors were found on regression analysis. CONCLUSION: Salpingectomy at the time of vaginal hysterectomy is a feasible procedure. Complication rates are low. Only pelvic adhesions are associated with failure to complete a salpingectomy.