In modern minimal access surgery, combining multiple procedures in a single sitting has become increasingly feasible due to advancements in laparoscopic and robotic techniques. One such combination, bilateral salpingectomy with appendicectomy, is often performed when both fallopian tubes require removal and the appendix is diseased or prophylactically targeted. In his lectures and demonstrations, Dr. R.K. Mishra, an authority in laparoscopic and robotic surgery, highlights the indications, technique, and benefits of performing these procedures simultaneously through a minimally invasive approach.

Understanding Bilateral Salpingectomy and Appendicectomy
Bilateral Salpingectomy

A salpingectomy refers to the surgical removal of one or both fallopian tubes. Bilateral salpingectomy involves removal of both tubes and is performed for:

Ectopic pregnancy involving both tubes or recurrent ectopic pregnancy

Hydrosalpinx leading to infertility

Tubal damage due to pelvic inflammatory disease

Risk-reducing surgery in women predisposed to ovarian or tubal cancers

Prophylaxis in women undergoing hysterectomy or sterilization

Appendicectomy

Appendicectomy is the removal of the vermiform appendix. It is most commonly performed for acute appendicitis, though sometimes it is carried out prophylactically during another abdominal surgery to avoid future appendicitis.

By combining these procedures laparoscopically, surgeons can treat both conditions in a single surgical session, sparing the patient multiple anesthetics and recovery phases.

Indications for Combined Procedure

Dr. Mishra emphasizes that bilateral salpingectomy with appendicectomy is considered in cases such as:

A woman with bilateral tubal disease and coexisting appendicitis.

Infertility patients with hydrosalpinx where bilateral tubes must be removed, and incidental appendicitis is discovered during diagnostic laparoscopy.

Gynecologic cancer prophylaxis where salpingectomy is planned, and appendicectomy is done for histopathological evaluation in mucinous ovarian tumors.

Chronic pelvic pain where both tubes and appendix are suspected contributors.

Surgical Technique

Dr. Mishra outlines a systematic laparoscopic approach for the combined procedure:

Patient Preparation

The patient is placed in lithotomy position under general anesthesia.

Proper antiseptic preparation and draping are performed.

Port Placement

A 10 mm umbilical port is inserted for the laparoscope.

Two or three 5 mm accessory ports are placed in the lower quadrants for working instruments.

Exploration

A diagnostic laparoscopy is performed to assess both adnexae, appendix, and pelvic organs.

Any adhesions are released to allow proper visualization.

Bilateral Salpingectomy

The fallopian tubes are grasped and elevated.

Using energy devices such as bipolar cautery or ultrasonic shears, the mesosalpinx is coagulated and divided.

The tube is detached from the uterus by sealing and cutting the uterotubal junction.

The same steps are repeated on the contralateral side.

Tubes are retrieved using endoscopic bags to avoid spillage.

Appendicectomy

The appendix is identified and mobilized by dividing the mesoappendix.

Appendicular artery is carefully coagulated or clipped.

The base of the appendix is ligated with endoloops, staplers, or sutures.

The appendix is excised and removed through a port.

Hemostasis and Closure

The operative field is inspected for bleeding.

Ports are closed after desufflation of the abdomen.

Advantages of Combined Procedure

Single Anesthetic Exposure: The patient undergoes both procedures under the same anesthesia, reducing risks.

Minimal Access: Small incisions mean less pain, faster recovery, and minimal scarring.

Cost-Effective: Avoids the need for two separate hospital admissions and surgeries.

Comprehensive Management: Addresses gynecological and gastrointestinal pathology in one sitting.

Enhanced Visualization: The laparoscope provides magnified views, ensuring precision in both salpingectomy and appendicectomy.

Faster Recovery: Patients often resume routine activities within a week.

Potential Risks and Complications

As with any laparoscopic surgery, risks exist, including:

Injury to bowel, bladder, or major vessels during trocar insertion

Bleeding from mesosalpinx or mesoappendix

Infection or abscess formation

Adhesion development, though less than in open surgery

Rare conversion to open surgery in cases of dense adhesions or uncontrolled bleeding

Dr. Mishra stresses that with proper training, careful dissection, and adherence to safety protocols, these risks can be minimized.

Postoperative Care

Patients are encouraged to ambulate early to prevent thromboembolic complications.

Oral intake is resumed within hours after surgery.

Analgesics and antibiotics are administered as required.

Most patients are discharged within 24–48 hours.

Conclusion

Bilateral salpingectomy with appendicectomy, when performed laparoscopically, exemplifies the efficiency and precision of minimal access surgery. By combining gynecological and gastrointestinal procedures in one session, surgeons can offer patients reduced pain, faster recovery, and comprehensive treatment.

As highlighted by Dr. R.K. Mishra, mastery of laparoscopic skills, careful case selection, and meticulous surgical technique are the cornerstones of success in such combined procedures. This approach reflects the growing role of laparoscopy in providing safe, effective, and patient-centered surgical care.