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A low-cost approach to salpingectomy at cesarean delivery

Published:January 23, 2020DOI:https://doi.org/10.1016/j.ajog.2019.12.275
      There is increasing adoption of opportunistic salpingectomy for ovarian cancer prevention at the time of gynecologic surgery, which includes the postpartum period. However, there is no consensus on an ideal surgical approach for the parturient vasculature. We describe a safe, low-cost, and accessible approach for bilateral salpingectomy during cesarean delivery that we call the “Mesosalpinx Isolation Salpingectomy Technique” (MIST) that can guide institutions to standardize their postpartum salpingectomy procedures when advanced vessel-sealing devices are not available. In the MIST technique, avascular windows are created within the mesosalpinx close to the tubal vessels. The vasculature is thus fully skeletonized and isolated from the adjacent mesosalpinx before suture ligation, which ensures security of the free-tie to the individual vessels and avoids sharp injury to the mesosalpinx. Not using vessel-sealing devices also eliminates the risk of thermal injury to the adjacent ovarian tissue and vasculature and potentially achieves a cost-savings for the hospital and patient. MIST has been performed in 141 cesarean deliveries in the past 4 years. There were no noted bleeding complications during the salpingectomy procedure, blood transfusions, or instances of postoperative surgical reexploration. In our experience, a surgeon who is new to the procedure takes approximately 15 minutes to complete a bilateral salpingectomy. Those surgeons who are experienced in MIST need only 5 minutes. A video is included that demonstrates the technique.

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      Linked Article

      • A low-cost approach for salpingectomy during cesarean delivery
        American Journal of Obstetrics & GynecologyVol. 223Issue 2
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          We want to congratulate Guo et al for their manuscript “A low-cost approach for salpingectomy during cesarean delivery.”1 Although we agree with the authors that having a cost-effective option for bilateral salpingectomy during cesarean delivery is important, we question the novelty of their surgical approach.
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        American Journal of Obstetrics & GynecologyVol. 223Issue 2
        • Preview
          We thank Duncan et al for their comments regarding our manuscript on a novel detailed approach for salpingectomy during cesarean delivery.1 Although there are a few studies2,3 describing and comparing sequential suture ligation of the tubal vasculature using a cut-clamp-tie technique, we argue that our mesosalpinx isolation salpingectomy technique (MIST) is unique in requiring the complete skeletonization of the tubal vasculature from the mesosalpinx before suture ligation. This modification promotes enhanced knot security on the tubal vessels and avoids suture ligating the tubal vasculature, thus minimizing sharp injury to the mesosalpinx.
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