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Am J Perinatol 2024; 41(06): 804-813
DOI: 10.1055/s-0042-1748525
Original Article

Feasibility, Safety, and Provider Perspectives of Bipolar Electrosurgical Cautery Device for (Opportunistic or Complete) Salpingectomy at the Time of Cesarean Delivery

Stuart A. Ostby
1   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
,
Christina T. Blanchard
1   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
,
Aalok R. Sanjanwala
2   Division of Maternal-Fetal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Jeff M. Szychowski
1   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
,
Charles A. Leath III
3   Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, Alabama
,
Warner K. Huh
3   Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, Alabama
,
Akila Subramaniam
1   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
› Institutsangaben Funding The authors acknowledge financial support from Medtronic, Covidien, LP (ERP 2017-11074) for this study as well as the Debora Kogan Lyda Ovarian Cancer Memorial Fund for the parent trial (SCORE, NCT02374827). Dr. Leath had the following support from the NCI 1UG1CA233330-01. Original trial data (NCT02374827) was presented at the Society for Maternal–Fetal Medicine 39th Annual Pregnancy Meeting, Grapevine TX.
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Abstract

Objective The aim of the study is to evaluate the use of a bipolar electrocautery device for complete salpingectomy at cesarean to improve procedure completion rates, operative time, and surgeon reported satisfaction as compared with standard bilateral tubal ligation (BTL) and suture-cut-tie salpingectomy.

Study Design This is a prospective cohort study of women undergoing planned, non-emergent cesarean with desired sterilization with complete salpingectomy utilizing a bipolar electrocautery device. Study patients were compared with historic controls from a randomized controlled trial (RCT) of complete salpingectomy via suture-cut-tie method versus BTL conducted at our institution (SCORE trial, NCT02374827). Outcomes were compared with groups from the original RCT.

Results Thirty-nine women were consecutively enrolled (12/2018–11/2019) into the device arm of the study and compared with the original SCORE cohort (n = 40 BTL, n = 40 salpingectomy without a device). Salpingectomy performance with the bipolar electrocautery device was successfully completed in 100% (39/39) of enrolled women, with one device failure requiring the use of a second device, as compared with 95% (38/40) in the BTL (p = 0.49) and 67.5% (27/40) in salpingectomies without a device (p < 0.001). Mean operative time of sterilization procedure alone demonstrated device use as having the shortest operative time of all (device salpingectomy 5.0 ± 3.6 vs. no device 18.5 ± 8.3 minutes, p < 0.001; and vs. BTL 6.9 ± 5.0, p = 0.032). Mean sterilization procedure endoscopic band ligation (EBL) was demonstrated to be significantly different between each group, least amongst BTL followed by device (6.3 ± 4.8 vs. 8.4 ± 24.8, p < 0.001), and most by suture-cut-tie method (17.7 ± 14.3, p < 0.001 compared with device). Surgeon reported attitudes of complete salpingectomy performance in general practice outside an academic setting was greater with a device than without (79.5 vs. 35.3%; p < 0.001).

Conclusion Use of a bipolar electrocautery device improved operative times and surgeon satisfaction for salpingectomy at cesarean over standard suture ligation. Device use improved surgeon reported outcomes and may improve incorporation of complete salpingectomy at cesarean.

Key Points

  • Electrocautery bipolar device use was safe at the time of salpingectomy during cesarean.

  • Greater surgeon satisfaction occurs using a device than without.

  • Decreased surgical time with device use is seen making the procedure equal to BTL.

Keywords

cesarean delivery - electrocautery - opportunistic salpingectomy - sterilization


Publikationsverlauf

Eingereicht: 08. Juli 2021

Angenommen: 18. Februar 2022

Artikel online veröffentlicht:
21. Juni 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Ovarian Cancer Statistics | How Common is Ovarian Cancer.. Accessed November 30, 2019 at: https://www.cancer.org/cancer/ovarian-cancer/about/key-statistics.html
    PubMed
  • 2 Lowe KA, Chia VM, Taylor A. et al. An international assessment of ovarian cancer incidence and mortality. Gynecol Oncol 2013; 130 (01) 107-114
    CrossrefPubMedGoogle Scholar
  • 3 Kindelberger DW, Lee Y, Miron A. et al. Intraepithelial carcinoma of the fimbria and pelvic serous carcinoma: evidence for a causal relationship. Am J Surg Pathol 2007; 31 (02) 161-169
    CrossrefPubMedGoogle Scholar
  • 4 Erickson BK, Conner MG, Landen Jr CN. The role of the fallopian tube in the origin of ovarian cancer. Am J Obstet Gynecol 2013; 209 (05) 409-414
    CrossrefPubMedGoogle Scholar
  • 5 Kurman RJ, Shih IeM. The origin and pathogenesis of epithelial ovarian cancer: a proposed unifying theory. Am J Surg Pathol 2010; 34 (03) 433-443
    CrossrefPubMedGoogle Scholar
  • 6 Prevention OC. Committee opinion no. 620: salpingectomy for ovarian cancer prevention. Obstet Gynecol 2015; 125 (01) 279-281
    CrossrefPubMedGoogle Scholar
  • 7 Walker JL, Powell CB, Chen LM. et al. Society of Gynecologic Oncology recommendations for the prevention of ovarian cancer. Cancer 2015; 121 (13) 2108-2120
    CrossrefPubMedGoogle Scholar
  • 8 Dilley SE, Straughn Jr JM, Leath III CA. The evolution of and evidence for opportunistic salpingectomy. Obstet Gynecol 2017; 130 (04) 814-824
    CrossrefPubMedGoogle Scholar
  • 9 Minig L, Chuang L, Patrono MG, Cárdenas-Rebollo JM, García-Donas J. Surgical outcomes and complications of prophylactic salpingectomy at the time of benign hysterectomy in premenopausal women. J Minim Invasive Gynecol 2015; 22 (04) 653-657
    CrossrefPubMedGoogle Scholar
  • 10 Vorwergk J, Radosa MP, Nicolaus K. et al. Prophylactic bilateral salpingectomy (PBS) to reduce ovarian cancer risk incorporated in standard premenopausal hysterectomy: complications and re-operation rate. J Cancer Res Clin Oncol 2014; 140 (05) 859-865
    CrossrefPubMedGoogle Scholar
  • 11 Hanley GE, McAlpine JN, Pearce CL, Miller D. The performance and safety of bilateral salpingectomy for ovarian cancer prevention in the United States. Am J Obstet Gynecol 2017; 216 (03) 270.e1-270.e9
    CrossrefPubMedGoogle Scholar
  • 12 Dilley SE, Havrilesky LJ, Bakkum-Gamez J. et al. Cost-effectiveness of opportunistic salpingectomy for ovarian cancer prevention. Gynecol Oncol 2017; 146 (02) 373-379
    CrossrefPubMedGoogle Scholar
  • 13 Kwon JS, McAlpine JN, Hanley GE. et al. Costs and benefits of opportunistic salpingectomy as an ovarian cancer prevention strategy. Obstet Gynecol 2015; 125 (02) 338-34
    CrossrefPubMedGoogle Scholar
  • 14 Chan LM, Westhoff CL. Tubal sterilization trends in the United States. Fertil Steril 2010; 94 (01) 1-6
    CrossrefPubMedGoogle Scholar
  • 15 Hamilton BE, Martin JA, Osterman MJK, Curtain SC. Births: preliminary data for 2014. Natl Vital Stat Rep 2015; 64 (06) 1-19
    PubMedGoogle Scholar
  • 16 Ganer Herman H, Gluck O, Keidar R. et al. Ovarian reserve following cesarean section with salpingectomy vs. tubal ligation: a randomized trial. Am J Obstet Gynecol 2017; 217 (04) 472.e1-472.e6
    CrossrefPubMedGoogle Scholar
  • 17 Danis RB, Della Badia CR, Richard SD. Postpartum permanent sterilization: could bilateral salpingectomy replace bilateral tubal ligation?. J Minim Invasive Gynecol 2016; 23 (06) 928-932
    CrossrefPubMedGoogle Scholar
  • 18 Shinar S, Blecher Y, Alpern S. et al. Total bilateral salpingectomy versus partial bilateral salpingectomy for permanent sterilization during cesarean delivery. Arch Gynecol Obstet 2017; 295 (05) 1185-1189
    CrossrefPubMedGoogle Scholar
  • 19 Lawrie TA, Nardin JM, Kulier R, Boulvain M. Techniques for the interruption of tubal patency for female sterilisation. Cochrane Database Syst Rev 2011; (02) CD003034
    PubMedGoogle Scholar
  • 20 Subramaniam A, Einerson BD, Blanchard CT. et al. The cost-effectiveness of opportunistic salpingectomy versus standard tubal ligation at the time of cesarean delivery for ovarian cancer risk reduction. Gynecol Oncol 2019; 152 (01) 127-132
    CrossrefPubMedGoogle Scholar
  • 21 Subramaniam A, Blanchard CT, Erickson BK. et al. Feasibility of complete salpingectomy compared with standard postpartum tubal ligation at cesarean delivery a randomized controlled trial. Obstet Gynecol 2018; Jul; 132 (01) 20-27
    CrossrefPubMedGoogle Scholar
  • 22 Venkatesh KK, Clark LH, Stamilio DM. Cost-effectiveness of opportunistic salpingectomy vs. tubal ligation at the time of cesarean delivery. Am J Obstet Gynecol 2019; 220 (01) 106.e1-106.e10
    CrossrefPubMedGoogle Scholar
  • 23 Garcia C, Moskowitz OM, Chisholm CA. et al. Salpingectomy compared with tubal ligation at cesarean delivery a randomized controlled trial. Obstet Gynecol 2018; 132 (01) 29-34
    CrossrefPubMedGoogle Scholar
  • 24 Mohamed AA, Yosef AH, James C, Al-Hussaini TK, Bedaiwy MA, Amer SAKS. Ovarian reserve after salpingectomy: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2017; 96 (07) 795-803
    CrossrefPubMedGoogle Scholar
  • 25 Kotlyar A, Gingold J, Shue S, Falcone T. The effect of salpingectomy on ovarian function. J Minim Invasive Gynecol 2017; 24 (04) 563-578
    CrossrefPubMedGoogle Scholar
  • 26 Yang M, Du Y, Hu Y. Complete salpingectomy versus tubal ligation during cesarean section: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2021; 34 (22) 3794-3802
    CrossrefPubMedGoogle Scholar
  • 27 Castellano T, Zerden M, Marsh L, Boggess K. Risks and benefits of salpingectomy at the time of sterilization. Obstet Gynecol Surv 2017; 72 (11) 663-668
    CrossrefPubMedGoogle Scholar
  • 28 Guo XM, Hall EF, Mazzullo L, Djordjevic M. A low-cost approach to salpingectomy at cesarean delivery. Am J Obstet Gynecol 2020; 222 (05) 503.e1-503.e3
    CrossrefPubMedGoogle Scholar