Randomized comparison between two microlaparoscopic techniques for partial salpingectomy

Abstract

Objective: We compared 2 techniques for performing a partial salpingectomy by using microlaparoscopy and either bipolar coagulation or loop ligation.

Methods: A 3-mm transumbilical laparoscope with secondary midline port sites midway and suprapubically was used to perform a partial salpingectomy in 109 women desiring permanent sterilization. Each patient was randomly assigned to undergo a tubal resection either after Pomeroy ligation (n= 54) or after bipolar coagulation with Kleppinger forceps (n=55). Postoperative pain, as assessed using a 10-point visual analog scale, was the primary comparison endpoint.

Results: No technical difficulties with either technique required conversion to a minilaparotomy. The mean time to remove both tubal segments was not different between techniques (7 minutes, 21 seconds; range, 4 minutes, 25 seconds to 15 minutes, 43 seconds). Each segment (mean, 1.6 cm; range, 0.8 to 3.5 cm) was confirmed in the operating room, then histologically. Postoperative pain at 6 hours was scored similarly (median, ligation 4.6, coagulation 4.0 of 10). Outpatient recovery was the same, unless pelvic pain required overnight observation (ligation, 4 patients; coagulation, 2 patients).

Conclusion: Partial salpingectomy, using microlaparoscopy with either bipolar coagulation or loop ligation, was performed with comparable ease, confirmation of the removed tube, and similar postoperative discomfort.

Figure 1.

Placement of port sites for the 3-mm laparoscope subumbilically, grasping forceps midway, and either Kleppinger forceps or endoloop instrument suprapubically.

Figure 2.

A microlaparoscopically directed partial salpingectomy involves either coagulating the proximal and distal mid-portion of the tube (A) or a loop of suture placed around the base of a loop of fallopian tube (B). The operative site should be reinspected for transected edges of the tubal segments and for hemostasis of the mesosalpinx.