This video demonstrate Bilateral Salpingectomy and Appendicectomy by Dr R K Mishra at World Laparoscopy Hospital. Salpingectomy refers to the surgical removal of a Fallopian tube and An appendectomy (sometimes called appendisectomy or appendicectomy) (English) is the surgical removal of the vermiform appendix.

Performing a Bilateral Salpingectomy with concomitant Appendicectomy is a sophisticated combined procedure that addresses both reproductive health and prophylactic or therapeutic gastrointestinal needs. Under the guidance and techniques pioneered by Dr. R.K. Mishra at World Laparoscopy Hospital, this "double procedure" is executed with a focus on surgical economy—minimizing port sites and anesthesia time while maximizing patient outcomes.

1. Clinical Indications for Combined Surgery

This dual approach is typically indicated in specific scenarios:

• Permanent Contraception/Cancer Prophylaxis: Removing both fallopian tubes (Salpingectomy) is now preferred over tubal ligation as it significantly reduces the future risk of ovarian cancer (which often starts in the fimbrial ends of the tubes).

• Pathology: Ectopic pregnancy, hydrosalpinx, or pelvic inflammatory disease (PID) affecting the tubes.

• Incidental or Symptomatic Appendicitis: While the surgeon is already in the pelvic cavity for the tubes, the appendix may be removed if it appears inflamed or as a "prophylactic" measure during a major pelvic overhaul to prevent future surgery.

2. The Mishra Technique: Surgical Flow

Dr. R.K. Mishra emphasizes a systematic "top-down" or "quadrant" approach to ensure no pathology is missed.

Step A: Patient Positioning and Access

• Trendelenburg Position: The patient is tilted head-down to allow gravity to move the bowel away from the pelvic organs.

• Port Placement: Usually a 10 mm umbilical port for the telescope and two 5 mm ports in the lateral lower quadrants. This "triangulation" allows the surgeon to reach both the left and right adnexa (tubes) and the right iliac fossa (appendix) without needing extra incisions.

Step B: Bilateral Salpingectomy

1. Grasping: The fallopian tube is grasped at the fimbrial end.

2. Desiccation: Using bipolar or ultrasonic shears, the mesosalpinx (the tissue attaching the tube to the broad ligament) is cauterized and cut.

3. Cornual Excision: The tube is separated from the uterus at the cornual end. Dr. Mishra teaches precision here to avoid excessive thermal damage to the uterine wall.

Step C: Laparoscopic Appendicectomy

Once the tubes are removed, the surgeon shifts focus to the cecum.

1. Identification: The "taenia coli" of the colon are followed to the base of the appendix.

2. Mesoappendix Ligation: The blood supply is controlled.

3. The Mishra’s Knot: As a hallmark of his teaching, Mishra’s Knot is applied to the appendiceal stump. This ensures a secure, leak-proof closure of the cecal base using cost-effective suture material rather than expensive staplers.

3. Advantages of the Combined Approach at WLH

Feature	Single Procedure (Salpingectomy only)	Combined (Mishra’s Approach)
Anesthesia	Same	Same (Single session)
Incision Number	3	3 (No additional ports needed)
Future Risk	Potential future appendicitis	Zero risk of appendicitis/ovarian cancer
Recovery	5–7 Days	5–7 Days (Minimal difference)

4. Intraoperative Safety Protocols

Dr. Mishra’s methodology includes several "safety checks":

• Ureter Identification: Before cutting the fallopian tubes, the surgeon must identify the ureter to prevent accidental injury.

• Hemostasis: A final "underwater" inspection (filling the pelvis with saline) is often performed to ensure there is no bleeding from the ovarian vessels or the appendiceal artery.

• Specimen Retrieval: All three specimens (two tubes and one appendix) are removed in a protective endobag to prevent any infected tissue or cells from touching the abdominal wall incisions.

5. Recovery and Post-Operative Care

Because both procedures are minimally invasive, the recovery is remarkably fast.

• Discharge: Usually within 24–48 hours.

• Pain Management: Multimodal analgesia, often including a local anesthetic "splash" on the surgical sites before closing.

• Return to Work: Typically within one week.

Conclusion

Bilateral Salpingectomy with Appendicectomy, when performed by experts trained in Dr. R.K. Mishra's techniques, is a masterclass in surgical efficiency. It offers the patient a "one-stop" solution for permanent contraception, cancer risk reduction, and the elimination of future appendicitis, all through three tiny punctures.