When this procedure is performed using an open technique it is most commonly performed in association with total abdominal hysterectomy. The steps described below are for isolated salpingo-oopherectomy and are slightly different than if the tube and ovaries are taken out en bloc with the uterus.
Malignancy – virtually all ovarian cancer requires removal of the Fallopian tube and ovary
Ectopic Pregnancy – this condition is when the fertilized egg is implanted in the Fallopian tube instead of the uterus. Ectopic pregnancy can cause rupture of the tube as the fetus develops and can be a surgical emergency.
Surgical Details of Procedure
1. A lower midline incision is made vertically (up and down) in the skin with a No. 10 scalpel.
2. Dissection is done through the subcutaneous tissue with Bovie cautery.
3. The midline between the rectus muscles is appreciated and the fascia is incised.
4. Some clinicians may elect to use a transverse skin incision called a Pfannenstiel incision placed just above the symphysis pubis (pubic bone).
5. In the transverse incision approach the subcutaneous tissue is dissected with Bovie cautery
6. Skin flaps are raised superiorly toward the skin to allow exposure of the midline of the rectus muscles.
7. Occasionally in large patients, the rectus muscles are cut to afford better exposure
8. After the midline fascia is dissected or the rectus musles are cut the peritoneum is appreciated and grasped with forceps on either side of the midline (never with hemostats to avoid trapping bowel inadvertently).
9. The uterus is pulled foward by an absorbably stay suture placed in the fundus or by grasping the uterus with a tenaculum.
10. Clamps are applied to the infundibulopelvic ligament that contains the ovarian vessels.
11. A clamp is applied to the Fallopian tube.
12. The Fallopian tube and ovary are pulled superiorly and an incision is made in the exposed broad ligament with a scalpel.
13. The ovarian vessels are visualized and ligated with 0 silk sutures.
14. The cut edges of the broad ligament are plicated with mattress sutures.
15. The section of the Fallopian tube inside the uterine wall is removed by making an ellipical incision around the base of the insertion site on the outside of the uterus.
16. Dissection is done through the muscle plane of the uterus until the Fallopian tube is freed.
17. The now full thickness opening in the uterus is closed using a mattress suture of an absorbably 0 suture.
18. The cut surface of the infundibulopelvic ligament is now covered by taking a bite of peritoneum on either side with a suture and plicating it over the ligament remnant.
19. The suspension of the uterus is done by shortening the round ligament by taking peritoneum on either side and plicating it along the length of the round ligament with 3 or 4 mattress sutures to insure midline suspension of the uterus.