An ectopic pregnancy occurs when a fertilized egg implants outside the uterine cavity, most commonly in the fallopian tube. This condition affects approximately 1–2% of pregnancies and remains a leading cause of maternal morbidity in the first trimester. Advances in minimally invasive surgery have transformed management, and laparoscopic salpingotomy is now a preferred fertility-preserving procedure for selected patients.

Understanding Ectopic Pregnancy

Ectopic pregnancies are most often tubal pregnancies, with implantation occurring in the ampullary or isthmic segment of the fallopian tube. Risk factors include:

Previous ectopic pregnancy

Pelvic inflammatory disease (PID)

Prior tubal or pelvic surgery

Use of assisted reproductive technology

Endometriosis

Smoking

Symptoms typically include abdominal pain, vaginal bleeding, and amenorrhea. If untreated, tubal rupture may lead to life-threatening intra-abdominal bleeding.

Treatment Options

Management of ectopic pregnancy depends on clinical stability, gestational age, size of the ectopic mass, and patient’s fertility desires.

Medical management with methotrexate is an option for early, unruptured ectopic pregnancies.

Surgical management is required if the ectopic is large, ruptured, or if medical therapy is contraindicated.

Surgical choices include salpingectomy (removal of the affected tube) or salpingotomy (conserving the tube by removing only the pregnancy).

What is Laparoscopic Salpingotomy?

Salpingotomy involves making a linear incision on the fallopian tube over the site of implantation and carefully removing the products of conception while preserving the tube. It is especially beneficial for women wishing to maintain fertility, provided the tube is not severely damaged.

At advanced centers such as World Laparoscopy Hospital, this technique is performed using high-definition laparoscopic visualization and precise microsurgical instruments, ensuring minimal trauma to the tube.

Indications for Salpingotomy

Hemodynamically stable patient

Desire for future fertility

Ectopic mass <4 cm in size

No significant tubal rupture or extensive damage

Contralateral tube is absent or diseased, making tubal preservation critical

If the tube is severely damaged or the patient does not desire future fertility, salpingectomy may be the preferred option.

Surgical Technique of Laparoscopic Salpingotomy
Patient Preparation

General anesthesia is administered.

The patient is placed in lithotomy position with a Trendelenburg tilt.

Ports are inserted—typically a 10 mm umbilical port for the camera and 5 mm accessory ports for instruments.

Exploration

A thorough inspection of the pelvis is performed to confirm the site of ectopic pregnancy and assess tubal condition.

Hemoperitoneum, if present, is aspirated.

Linear Salpingotomy

Using monopolar hook or harmonic scalpel, a linear incision is made on the antimesenteric border of the tube directly over the ectopic swelling.

The incision is just large enough to allow removal of the gestational tissue.

Removal of Products of Conception

The ectopic tissue is gently expressed or removed using atraumatic forceps and irrigation.

Care is taken to avoid damaging the tubal mucosa.

Hemostasis

Minimal bipolar coagulation or pressure is applied to achieve hemostasis.

Suturing is generally avoided to prevent narrowing of the tube; the incision is left to heal by secondary intention.

Peritoneal Toilet

Copious irrigation is performed to remove blood clots and trophoblastic tissue.

This reduces the risk of persistent trophoblast and adhesion formation.

Postoperative Care

Hospital Stay: Most patients are discharged within 24 hours.

Pain Management: Minimal, managed with oral analgesics.

Monitoring: Serial serum β-hCG levels are followed until they return to normal, to rule out persistent ectopic pregnancy.

Fertility Counseling: Patients are advised about recurrence risks and the need for early ultrasound in subsequent pregnancies.

Outcomes and Benefits

Laparoscopic salpingotomy offers several advantages:

Fertility preservation: Tubal integrity is maintained.

Minimally invasive: Smaller incisions, less pain, and faster recovery.

Lower adhesion formation: Compared to open surgery.

Short hospital stay: Quick return to normal activities.

Studies suggest that subsequent intrauterine pregnancy rates after salpingotomy are comparable to salpingectomy, but the procedure is especially valuable when the contralateral tube is compromised.

Risks and Considerations

Persistent trophoblast: Residual tissue may continue to grow, requiring methotrexate or repeat surgery.

Recurrence of ectopic pregnancy: Risk remains, especially in damaged tubes.

Tubal damage: Though rare, scar formation can still impact future fertility.

Careful patient selection and meticulous surgical technique minimize these risks.

Conclusion

Laparoscopic salpingotomy is a safe and effective fertility-preserving option for managing selected cases of ectopic pregnancy. By removing the ectopic gestation while conserving the fallopian tube, it balances surgical success with reproductive potential.

At specialized centers like World Laparoscopy Hospital, under the guidance of experts such as Dr. R. K. Mishra, this procedure is performed with precision and advanced laparoscopic methods, ensuring excellent outcomes for women worldwide. With proper postoperative monitoring and fertility counseling, laparoscopic salpingotomy represents a modern, patient-centered approach in gynecological surgery.