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A randomized controlled trial of 2 techniques of salpingectomy during cesarean delivery

  • Roy Lauterbach
    Correspondence
    Corresponding author: Roy Lauterbach, MD.
    Affiliations
    Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein)
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  • Oren Gruenwald
    Affiliations
    Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein)
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  • Emad Matanes
    Affiliations
    Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein)
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  • Naphtali Justman
    Affiliations
    Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein)
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  • Omer Mor
    Affiliations
    Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein)
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  • Dana Vitner
    Affiliations
    Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein)

    The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Drs Vitner, Weiner, and Lowenstein)
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  • Roni Avrahami
    Affiliations
    Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein)
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  • Nadir Ghanem
    Affiliations
    Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein)
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  • Yaniv Zipori
    Affiliations
    Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein)
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  • Zeev Weiner
    Affiliations
    Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein)

    The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Drs Vitner, Weiner, and Lowenstein)
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  • Lior Lowenstein
    Affiliations
    Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs Lauterbach, Gruenwald, Matanes, Justman, Mor, Vitner, Avrahami, Ghanem, Zipori, Weiner, and Lowenstein)

    The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Drs Vitner, Weiner, and Lowenstein)
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      BACKGROUND

      Total salpingectomy during benign gynecologic surgery is recommended after completion of childbearing to reduce the risk of developing ovarian cancer.

      OBJECTIVE

      This study aimed to assess operating time and complication rates of “traditional” salpingectomy using the “Knot and Cut” technique, compared with bipolar salpingectomy for sterilization at the time of cesarean delivery.

      STUDY DESIGN

      This was a randomized controlled trial. Women undergoing planned cesarean delivery who desired sterilization were randomized to traditional salpingectomy or bipolar salpingectomy. The bipolar salpingectomy was performed using the LigaSure Precise. The primary outcome was the surgical time of the salpingectomy procedure. Secondary outcomes included total cesarean delivery time and associated bleeding parameters. We estimated that 42 patients would provide 80% power and a 2-sided alpha of 0.05 to identify a 10-minute difference in the primary outcome.

      RESULTS

      A total of 26 women were randomized to bipolar salpingectomy and 25 to traditional salpingectomy. Baseline demographic characteristics were similar between the groups. Six procedures were converted from traditional to bipolar salpingectomy, and 2 traditional salpingectomies failed. The surgical time (16.16±9.53 vs 5.19±3.57 minutes; P<.001), estimated blood loss (928.08±414.66 mL vs 677.15±380.42 mL; P=.029), and need for blood transfusion (20% vs 0%; P=.016) were significantly greater in the traditional salpingectomy than in the bipolar salpingectomy group. The cesarean delivery time was similar (88.92±17.87 vs 88.23±19.85 minutes; P=.89). Hospitalization time was significantly longer following traditional salpingectomy than bipolar salpingectomy (5.24±2.27 vs 3.92±2.01 days; P=.034).

      CONCLUSION

      “Traditional” salpingectomy is associated with longer surgical and hospitalization time, and greater blood loss and risk of blood transfusion compared with “bipolar” salpingectomy. In practices in which “bipolar” salpingectomy is available, it should be preferred over alternative methods of salpingectomy.

      Key words

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