Laparoscopy:
The range of surgical procedures in gynecology performed with the use of laparoscopy is termed as laparoscopic surgery. With very fast technological advancements, as much as 80% of surgery can be performed by this method.
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:
- Unilateral salpingectomy: When only one fallopian tube from either side is removed, it is called unilateral salpingectomy.
- Bilateral salpingectomy: When both fallopian tubes are removed from both sides of the ovaries, then it is termed as bilateral salpingectomy.
- Partial salpingectomy: When only a part of the fallopian tube is removed, then it is termed as a partial salpingectomy.
- Total salpingectomy: When the entire fallopian tube is removed, then it is termed as total salpingectomy.
- Salpingo-oophorectomy: When the ovaries are also removed along with the fallopian tubes, then it is termed as a salpingo-oophorectomy.
Before the procedure:
- Common routine tests
It includes the general tests that are common to all surgical procedures and are performed before the surgery like:
ECG
Blood test
Urine test
Chest X-ray
- Abdominal and pelvic ultrasound
The image below the abdomen is viewed on the screen to determine the underlying cause of the issue.
- Hysterosalpingogram
This is performed to check if the fallopian tube is blocked. To achieve this, a contrast medium is introduced into the uterus through the vaginal passage.
Consult your doctor regarding what to eat and how long before the procedure you should stop eating. You can opt for abdominal surgery as an alternative to laparoscopic surgery, therefore make sure to mention all your doubts and discuss with your doctor to decide the best approach for you. Salpingectomy has some effects and complications after the surgery, so it is important to discuss with your doctor about all the precautions and care to be taken and followed.
During the procedure:
- You will be given a general or regional anesthesia to relieve the pain during the surgery.
- You will be rested in a lithotomy position, that is your legs will be rested higher than your level over some support.
- In the laparoscopic approach, small incisions are made near your belly button through which laparoscope and other microsurgical instruments are inserted.
- Carbon dioxide gas is pumped into the abdominal cavity to provide a better view of the organs which helps the surgeon to use the instruments properly and avoid injuries. Also, the abdominal walls are separated from the organs which prevent injury to these organs.
- After the surgeon reaches the fallopian tubes, he/she ties the tubes at the uterus end and cut it out.
- Another incision is made to remove the cut fallopian tubes.
- Lastly, all the incisions are stitched.
Advantages of laparoscopic surgery:
- 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 patients satisfaction
Disadvantages of Laparoscopic surgery:
- 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
Basic instruments used:
- Telescope: The angle of view can be either straight forward, that is, at 0 degrees, or oblique, that is, at 30 degrees.
- Veress needle: It is used to create a space which is filled with carbon dioxide. To prevent visceral injury, it is spring loaded.
- Trocar and cannula: It is inserted through the abdominal wall following the carbon dioxide space. After removing the trocar, a telescope is inserted through the cannula. These trocars and cannula are also available in disposable form.
- Light source: A high-intensity light, usually, xenon or halogen, the source is used for better visualization. Fiber-optic cables are used to transmit this light to the telescope.
- Imaging system: light source, camera units, laparoscope, fiber optic cords, and monitor.
- Camera unit: The three main parts of the camera are the camera head, cable, and camera control.
- Monitors: High resolution colored monitors are used.
- Insufflator: It displays the rate of gas flow and pressure in the air space created in the abdomen and hence it helps to control the number of gas leaks through the ports.
Complications of Laparoscopic approach:
- Injury to the bowel: This usually happens in case of adhesions with trocars or veress needle.
- Injury to blood vessels: injury caused to major pelvic or abdominal artery or vein usually caused during insertion of trocars.
- Electrosurgical complications: like electrode burns, injury due to insulation defects.
- Injury to organs: mechanical injury might be caused during dissection to organs like bowel, bladder, and ureter.
- Gas embolism leading to cardiac arrhythmia and hypotension.
Anesthetic complications:
- Aspiration
- Cardiac arrest
- Basal lung compression
- Hypercarbia, in case of excess CO2
- Metabolic acidosis
Common surgical complications:
- Port site hernia
- Hemorrhage
- Infection
- Wound dehiscence
