A randomized controlled trial of 2 techniques of salpingectomy during cesarean delivery

Roy Lauterbach; Oren Gruenwald; Emad Matanes; Naphtali Justman; Omer Mor; Dana Vitner; Roni Avrahami; Nadir Ghanem; Yaniv Zipori; Zeev Weiner; Lior Lowenstein

doi:10.1016/j.ajogmf.2022.100690

A randomized controlled trial of 2 techniques of salpingectomy during cesarean delivery

Am J Obstet Gynecol MFM. 2022 Nov;4(6):100690. doi: 10.1016/j.ajogmf.2022.100690. Epub 2022 Jul 16.

Authors

Affiliations

¹ Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein). Electronic address: roylauter@gmail.com.
² Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein).
³ Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein); The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Drs Vitner, Weiner, and Lowenstein).

PMID: 35843545
DOI: 10.1016/j.ajogmf.2022.100690

Abstract

Background: Total salpingectomy during benign gynecologic surgery is recommended after completion of childbearing to reduce the risk of developing ovarian cancer.

Objective: This study aimed to assess operating time and complication rates of "traditional" salpingectomy using the "Knot and Cut" technique, compared with bipolar salpingectomy for sterilization at the time of cesarean delivery.

Study design: This was a randomized controlled trial. Women undergoing planned cesarean delivery who desired sterilization were randomized to traditional salpingectomy or bipolar salpingectomy. The bipolar salpingectomy was performed using the LigaSure Precise. The primary outcome was the surgical time of the salpingectomy procedure. Secondary outcomes included total cesarean delivery time and associated bleeding parameters. We estimated that 42 patients would provide 80% power and a 2-sided alpha of 0.05 to identify a 10-minute difference in the primary outcome.

Results: A total of 26 women were randomized to bipolar salpingectomy and 25 to traditional salpingectomy. Baseline demographic characteristics were similar between the groups. Six procedures were converted from traditional to bipolar salpingectomy, and 2 traditional salpingectomies failed. The surgical time (16.16±9.53 vs 5.19±3.57 minutes; P<.001), estimated blood loss (928.08±414.66 mL vs 677.15±380.42 mL; P=.029), and need for blood transfusion (20% vs 0%; P=.016) were significantly greater in the traditional salpingectomy than in the bipolar salpingectomy group. The cesarean delivery time was similar (88.92±17.87 vs 88.23±19.85 minutes; P=.89). Hospitalization time was significantly longer following traditional salpingectomy than bipolar salpingectomy (5.24±2.27 vs 3.92±2.01 days; P=.034).

Conclusion: "Traditional" salpingectomy is associated with longer surgical and hospitalization time, and greater blood loss and risk of blood transfusion compared with "bipolar" salpingectomy. In practices in which "bipolar" salpingectomy is available, it should be preferred over alternative methods of salpingectomy.

Keywords: bipolar salpingectomy; cesarean delivery; surgical complications; traditional salpingectomy.