The advent of advanced laparoscopy has revolutionized the way gynecological conditions are treated, offering patients less invasive solutions with faster recovery. Among the wide spectrum of laparoscopic procedures, laparoscopic myomectomy and laparoscopic salpingectomy are frequently performed surgeries that address different but sometimes coexisting pathologies. In many patients, uterine fibroids (myomas) and diseased fallopian tubes may require simultaneous management, and laparoscopic surgery provides the opportunity to address both in a single operative session with minimal morbidity.

Understanding the Pathologies

Uterine Myomas (Fibroids):
Fibroids are benign smooth muscle tumors of the uterus that affect a large proportion of women in reproductive age. They may be single or multiple, located intramurally, subserosally, or submucosally. Symptomatic fibroids can cause heavy menstrual bleeding, pelvic pressure, pain, infertility, and recurrent pregnancy loss. Myomectomy is the surgery of choice for women desiring uterine conservation and future fertility.

Fallopian Tube Pathologies:
Diseased or damaged fallopian tubes can lead to chronic pelvic pain, hydrosalpinx, ectopic pregnancy, or infertility. A salpingectomy, or surgical removal of the fallopian tube, may be indicated in cases of:

Hydrosalpinx impairing fertility or affecting outcomes of in-vitro fertilization (IVF).

Irreparably damaged tubes due to infection, endometriosis, or previous surgery.

Tubal ectopic pregnancy when conservative management is not feasible.

Risk-reducing surgery in women predisposed to ovarian cancer, as prophylactic salpingectomy reduces the risk.

Indications for Combined Procedure

A patient may require laparoscopic myomectomy along with salpingectomy in several clinical scenarios, such as:

Symptomatic fibroids coexisting with hydrosalpinx in an infertile patient preparing for IVF.

Fibroids causing uterine distortion along with recurrent ectopic pregnancies requiring salpingectomy.

Benign adnexal pathology in a patient undergoing myomectomy for fibroids.

Prophylactic removal of the fallopian tubes in women undergoing myomectomy who are at higher risk of tubo-ovarian malignancy.

Performing both procedures together spares the patient multiple operations, reduces anesthesia exposure, and expedites recovery.

Preoperative Evaluation

Careful preoperative planning is essential for combined laparoscopic myomectomy and salpingectomy. This includes:

Ultrasound or MRI to map fibroids and assess the size, number, and location.

Tubal evaluation with ultrasound, hysterosalpingography, or laparoscopy if infertility is a concern.

Laboratory tests including complete blood count, hormonal assays, and infection screening.

Patient counseling regarding the nature of the surgeries, fertility implications, possible complications, and recovery timeline.

Surgical Technique

Anesthesia and Positioning:
The patient is positioned in lithotomy under general anesthesia. Pneumoperitoneum is established and trocars are inserted, usually three or four ports depending on surgical complexity.

Laparoscopic Myomectomy

The uterus is visualized, and fibroids are mapped.

A uterine incision is made over the most prominent fibroid using monopolar cautery or ultrasonic shears.

The fibroid is enucleated using traction and countertraction techniques.

Hemostasis is secured, and the myoma bed is sutured laparoscopically in multiple layers to restore uterine integrity.

Additional fibroids are similarly excised. Morcellation is often used to extract the fibroids.

Laparoscopic Salpingectomy

The affected fallopian tube is identified.

Using bipolar cautery or advanced energy devices, the mesosalpinx is coagulated and divided.

The tube is separated from the uterus at the uterotubal junction and excised completely.

Care is taken to preserve the ovary and its blood supply during dissection.

Specimen Retrieval:
Excised fibroids are removed by morcellation, while the fallopian tube is retrieved intact, usually in a specimen bag if required.

Postoperative Care

Recovery after combined laparoscopic surgery is typically rapid. The patient can start oral intake within hours, and ambulation is encouraged on the same day. Pain is minimal compared to open surgery, and most patients can be discharged within 24–48 hours.

Patients are advised to avoid heavy activities for a few weeks. Women desiring conception after myomectomy are generally counseled to wait 3–6 months to allow proper uterine healing. Fertility specialists may initiate IVF planning once healing is complete if salpingectomy was performed for hydrosalpinx.

Benefits of Combined Laparoscopic Approach

Single anesthesia and operative session for both conditions.

Minimally invasive with faster recovery and less pain.

Fertility optimization by removing fibroids and diseased tubes simultaneously.

Reduced hospital stay and lower overall cost.

Better cosmetic outcomes with small incisions.

Conclusion

Laparoscopic myomectomy and salpingectomy performed together represent an advanced, patient-centered approach in modern gynecology. This combined surgery allows comprehensive management of uterine and tubal pathology while preserving or optimizing reproductive potential. With precise preoperative planning, skilled laparoscopic technique, and meticulous postoperative care, outcomes are excellent, making this minimally invasive combination a preferred choice for many patients. As laparoscopic expertise continues to evolve, such dual procedures will further enhance the scope of fertility-preserving and restorative gynecologic surgery.