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OBJECTIVE: To evaluate the effect of video-based coaching on the gynecology resident performance of laparoscopic salpingectomy. METHODS: PGY-1 and PGY-2 residents were randomized before their gynecology rotations to standard gynecology curriculum (control group) or standard curriculum plus two video-coaching sessions by a fellowship- trained minimally invasive gynecologic surgeon (VBC group). Residents were video recorded intraoperatively performing three unilateral laparoscopic salpingectomies. Participants in the VBC group were coached between the procedures. The primary outcome was the improvement in modified GOALS (Global Operative Assessment of Laparoscopic Skills) and OSA-LS (Objective Structured Assessment of Laparoscopic Salpingectomy) scores, compared with baseline, in the VBC and control groups, with videos independently graded by three blinded minimally invasive gynecologic surgeons. A minimum sample size of 18 participants (nine per group) was needed to achieve 90% power to detect a difference of 5.0 points. RESULTS: From October 2021 to December 2022, 28 PGY-1 and PGY-2 residents completed the study with 14 participants per group. Baseline characteristics were similar between groups. In the VBC group, modified GOALS scores significantly improved by 3.0 points from video 1 to video 2 (P5.04) and by 3.2 points from video 1 to video 3 (P5.02). Modified OSA-LS scores also increased significantly in the VBC group, by 6.1 points from video 1 to video 3 (P5.02). In the control group, modified GOALS and OSA-LS scores improved from baseline but were not significant (P5.2, P5.5). Video-based coaching also enhanced resident comfort and confidence in performing laparoscopic surgery. CONCLUSION: Video-based coaching improves resident performance of laparoscopic salpingectomy and can be used as an adjunct to resident surgical training. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT05103449. [ABSTRACT FROM AUTHOR]

BACKGROUND: The cumulative lifetime risk of ovarian cancer is 16–68% and 11–30% in female BRCA1 and BRCA2 gene alteration carriers, respectively. Risk-reducing bilateral salpingo-oophorectomy (RRSO) is the only proven way to reduce ovarian cancer mortality. We report a series of patients who underwent risk-reducing surgery at the time of planned obstetric-indicated cesarean delivery. CASES: This is a case series of four women carrying a pathogenic germline BRCA1 or BRCA2 gene alteration who underwent RRSO at the time of cesarean delivery between March 1, 2018, and March 31, 2022. All women were referred during pregnancy to the University College London Hospitals Familial Cancer Clinic for consideration of RRSO at the time of obstetric-indicated cesarean delivery. Women were considered eligible for RRSO if they had a proven pathogenic germline alteration, would have completed childbearing after the cesarean delivery, and were older than age 35 or 40 years with BRCA1 or BRCA2 alterations, respectively. Operating time, blood loss, transfusion requirements, length of hospital stay, complications, and ability to breastfeed were assessed and, where possible, compared with the institutional means for similar patients who underwent cesarean delivery only, to determine whether RRSO was associated with increased morbidity. Women were contacted 11–59 months postprocedure to assess satisfaction. The mean blood loss was 687 mL (range 400–1,000 mL), mean operating time was 68 minutes, mean length of hospital stay was 3 days, and mean change in hemoglobin was −1 g/dL. No patient required a transfusion, had internal organ damage, returned to the operating room, or was readmitted. One of two women with intact breast tissue successfully breastfed, and the other chose to bottle feed. The mean contemporaneous institutional blood loss for cesarean delivery was not significantly different at 681 mL for singleton pregnancies and 872 mL for twin pregnancies. All four women reported a high level of satisfaction with the combined procedure. CONCLUSION: Our results show that RRSO can be performed at the time of cesarean delivery with high patient satisfaction. This approach can be offered to appropriately counseled individuals, with the benefit of avoiding the need for two separate procedures, with potentially reduced patient morbidity and health care costs. [ABSTRACT FROM AUTHOR]

In this narrative review, we describe evidence regarding the associated risks, benefits, and cost effectiveness of postpartum complete salpingectomy compared with partial salpingectomy. Permanent contraception can be performed via several methods, but complete salpingectomy is becoming more common secondary to its coincident benefit of ovarian cancer risk reduction. Small prospective studies and larger retrospective cohort studies have demonstrated the feasibility and safety of complete salpingectomy in the postpartum period. Additionally, multiple cost-effectiveness analyses have demonstrated the cost effectiveness of this method secondary to ovarian cancer reduction over the life span. Although future larger cohort studies will allow for more precise estimates of the effect of complete salpingectomy on ovarian cancer risk and incidence of rare complications, current data suggest that complete salpingectomy should be offered to patients as a method of permanent contraception in the postpartum period. [ABSTRACT FROM AUTHOR]

After vaginal delivery, opportunistic salpingectomy is more cost effective than bilateral tubal ligation for reducing the risk of ovarian cancer. OBJECTIVE: To compare the cost effectiveness of opportunistic salpingectomy and bilateral tubal ligation for sterilization immediately after vaginal delivery. METHODS: A cost-effectiveness analytic decision model was used to compare opportunistic salpingectomy with bilateral tubal ligation during vaginal delivery admission. Probability and cost inputs were derived from local data and available literature. Salpingectomy was assumed to be performed with a handheld bipolar energy device. The primary outcome was the incremental cost-effectiveness ratio (ICER) in 2019 U.S. dollars per quality-adjusted life-year (QALY) at a cost-effectiveness threshold of $100,000/QALY. Sensitivity analyses were performed to determine the proportion of simulations in which salpingectomy would be cost effective. RESULTS: Opportunistic salpingectomy was more cost effective than bilateral tubal ligation with an ICER of $26,150/QALY. In 10,000 patients desiring sterilization after vaginal delivery, opportunistic salpingectomy would result in 25 fewer ovarian cancer cases, 19 fewer ovarian cancer deaths, and 116 fewer unintended pregnancies than bilateral tubal ligation. In sensitivity analysis, salpingectomy was cost effective in 89.8% of simulations and cost saving in 13% of simulations. CONCLUSION: In patients undergoing sterilization immediately after vaginal deliveries, opportunistic salpingectomy is more cost effective and may be more cost saving than bilateral tubal ligation for reducing ovarian cancer risk. [ABSTRACT FROM AUTHOR]

Anti-müllerian hormone levels decline similarly in patients who have hysterectomy with conservation of one or both ovaries when compared with patients undergoing natural menopause. OBJECTIVE: To evaluate the relationship between hysterectomy with and without ovarian conservation and the onset of ovarian failure using anti-müllerian hormone (AMH) levels and imputed final menstrual period (FMP). METHODS: A total of 1,428 women with an observed FMP and 232 women who underwent hysterectomy (159 with bilateral salpingo-oophorectomy [BSO], 13 with one ovary conserved, and 60 with both ovaries conserved) and who had serial AMH measurements were included from SWAN (The Study of Women's Health Across the Nation), a multi-ethnic, multi-site, community-based study. Anti-müllerian hormone levels were sampled annually with at least one presurgery or pre-FMP measurement at least one postsurgery or post-FMP measurement. Surgery-related differences in patterns of AMH levels with respect to surgery date or FMP were estimated using piecewise linear mixed modeling; differences in age at first undetectable AMH level were estimated using survival analyses. RESULTS: Patients with conservation of one or both ovaries or natural menopause demonstrated similar patterns of decline in AMH levels when anchored to surgery or FMP. Patients with hysterectomy (all types) had a later counterfactual FMP (52.9±0.2 SEM) compared with the observed FMP in those with natural menopause (52.1±0.1 years, P =.002). Those undergoing BSO had an immediate reduction in AMH level to undetectable after surgery. CONCLUSION: Hysterectomy does not lead to a more rapid decline in AMH levels postoperatively compared with natural menopause. Patients undergoing BSO have a rapid loss of AMH, consistent with complete removal of the ovaries. These data suggest that hysterectomy as currently performed does not compromise ovarian reserve. [ABSTRACT FROM AUTHOR]

Objective: To evaluate trends in the incidence of premenopausal unilateral and bilateral oophorectomy between 1950 and 2018.Methods: The Rochester Epidemiology Project medical records-linkage system was used to identify all women aged 18-49 years who were residents of Olmsted County, Minnesota, and underwent unilateral or bilateral oophorectomy before spontaneous menopause between January 1, 1950, and December 31, 2018. Population denominators were derived from the U.S. Decennial Censuses for the years 1950-2010, and intercensal year population denominators were linearly interpolated. For 2011-2018, the annual population denominators were obtained from the U.S. Census projections. Where appropriate, overall incidence rates were age-adjusted to the total U.S. female population from the 2010 Census.Results: There were 5,154 oophorectomies in Olmsted County across the 69-year period between 1950 and 2018, and 2.9% showed malignant disease on pathology. A total of 2,092 (40.6%) women underwent unilateral oophorectomy, and 3,062 (59.4%) women underwent bilateral oophorectomy. More than half (n=1,750, 57.2%) of the bilateral oophorectomies occurred between 1990 and 2009. Until 1975-1979, the incidence of unilateral oophorectomy was mostly higher than bilateral oophorectomy. From 1980-1984 until 2000-2004, the incidence of bilateral oophorectomy more than doubled and the incidence of unilateral oophorectomy declined. After 2005, both procedures declined and converged to a similar incidence in 2015-2018. The decline in premenopausal bilateral oophorectomy over the past 14 years (2005-2018) was most pronounced for women who underwent oophorectomy concurrently with hysterectomy or did not have any ovarian indication.Conclusion: The incidence rates of unilateral and bilateral oophorectomy have varied greatly across the 69-year period of this study. In the past 14 years, the incidence of premenopausal unilateral and bilateral oophorectomy has decreased. These trends reflect the effects of the initial 2005-2006 publications and the subsequent expanding body of evidence against the practice of oophorectomy for noncancer indications. [ABSTRACT FROM AUTHOR]

Objective: To describe the clinical characteristics of transmasculine individuals who underwent hysterectomy and characterize surgical pathology findings.Methods: Under an institutional review board-approved protocol, transmasculine individuals who were undergoing hysterectomy and bilateral salpingectomy or bilateral salpingo-oophorectomy were retrospectively identified from a single institution. Past medical, surgical, obstetric, and gynecologic history were collected, including prior testosterone use, cervical cancer screening status, and preoperative pelvic imaging. Surgical pathologic findings of the endometrium, ovaries, and cervix were collected.Results: A total of 72 individuals were included. The median age was 30 years (range 19-51). The majority of patients had private insurance (n=53, 74%) and were on testosterone at time of the preoperative visit (n=63, 88%). Forty-two patients (58%) reported anxiety, depression, or bipolar disorder, and 34 patients (47%) were taking an antidepressant or mood stabilizer. Of the 68 patients eligible for cervical cancer screening, 33 (49%) were up to date before their surgical consultation visits. Pelvic pain was the leading indication for surgery (n=65, 90%), and 29 patients (40%) had multiple listed indications for surgery. Surgical pathology results included cervical intraepithelial neoplasia 2-3 in three patients (4%), endometrial or cervical atrophy in 13 patients (18%), and ovarian or paratubal cysts in 16 patients (22%).Conclusion: This study describes the distinct clinical characteristics and surgical pathology findings that health care professionals should consider when caring for this unique patient population, including a relatively high rate of mental health conditions, pelvic pain as the leading indication for surgery, and the presence of endometrial or cervical atrophy and ovarian or paratubal cysts on surgical pathology. [ABSTRACT FROM AUTHOR]

Graph: Vanessa L. Jacoby, MD, MAS Graph: George Sawaya, MD The pendulum continues to swing for the practice of elective oophorectomy at the time of hysterectomy for benign gynecologic conditions. A revised Markov model evaluating oophorectomy at the time of benign hysterectomy: age 65 years revisited. Rush et al conclude that oophorectomy at the time of hysterectomy for women aged 50 years or older results in a similar mortality rate by age 80 as hysterectomy with ovarian retention. [Extracted from the article]

Objective: To compare operative outcomes of postpartum salpingectomy and tubal ligation after vaginal delivery.Methods: This retrospective cohort study identified patients who underwent tubal sterilization between January 1, 2009, and December 31, 2019, at a large academic hospital, using the electronic medical record. All patients who delivered vaginally and underwent tubal sterilization during their delivery admissions were included. The primary outcome was total operative time. Secondary outcomes included estimated blood loss, perioperative complications, and readmission within 6 weeks postpartum. Patients who underwent bilateral tubal ligation were compared with those who underwent bilateral salpingectomy using Pearson's χ2 test, Fisher exact, and Student's t test.Results: A total of 317 eligible patients were identified. One hundred and six (94%) salpingectomies were completed using a bipolar electrocautery device. Operative time was 3 minutes shorter in the salpingectomy group, 30 minutes (interquartile range 24-38) compared with 33.5 (26-42) minutes, P=.032. Patients who underwent salpingectomy were more likely to have estimated blood loss of 5 mL or less (our institutional shorthand for minimal blood loss) than women who underwent bilateral tubal ligation (78 [69%] vs 112 [55%], P=.015). There were no significant differences in perioperative complications between the groups.Conclusion: When using electrocautery, bilateral salpingectomy can be completed in the immediate postpartum period after vaginal delivery with equivalent operative times to bilateral tubal ligation. [ABSTRACT FROM AUTHOR]

Background: Women with germline BRCA1 or BRCA2 mutations have a lifetime risk of ovarian cancer of up to 46%. Opportunistic salpingectomy has been advocated as a risk-reducing strategy owing to increasing recognition of tubal origin, yet evidence of efficacy in this high-risk population is limited.Case: This is the case of a woman with a BRCA1 mutation who underwent prophylactic mastectomy and bilateral salpingectomy with ovarian retention before the age of 40 years. She did not undergo oophorectomy and subsequently developed stage IV high-grade serous ovarian cancer 4 years after her initial surgery.Conclusion: More research is needed to determine the role of prophylactic salpingectomy with delayed oophorectomy, optimal timing of completion oophorectomy, and the risks and benefits compared with up-front risk-reducing salpingo-oophorectomy. [ABSTRACT FROM AUTHOR]

Objective: To compare the differences in operative time and surgical outcomes between salpingectomy and standard tubal interruption at the time of cesarean delivery.Data Sources: PubMed, Medline, Google Scholar, Cochrane, and ClinicalTrials.gov were searched from inception until July 2019 for articles reporting outcomes for women undergoing salpingectomy during cesarean delivery compared with women undergoing standard sterilization methods.Methods Of Study Selection: Studies were selected if they included the main outcome of operative time or additional outcomes, which included infection, transfusion, readmission, change in hematocrit, and estimated blood loss. The Newcastle-Ottawa Quality Assessment scale or Cochrane Handbook were used to assess quality of cohort and randomized controlled trials (RCTs), respectively. A random-effects model was employed to calculate pooled relative risk or weighted mean difference for each outcome with their 95% CI. Heterogeneity was assessed using the I statistic, and L'Abbé plots were inspected visually to assess for homogeneity.Tabulation, Integration, and Results: We identified 11 studies comprising 320,443 women undergoing total salpingectomy or standard sterilization methods at the time of cesarean delivery. Three RCTs and eight retrospective cohort studies were investigated separately by meta-analysis. When compared with standard sterilization methods, total operative time for patients receiving salpingectomy was significantly longer (6.3 minutes, 95% CI 3.5-9.1, seven studies, 7,303 patients) for cohort studies. With the three RCTs of 163 patients, total operative time was not significantly increased in women receiving salpingectomy (8.1 minutes, 95% CI -4.4 to 20.7). The salpingectomy group did not have an increased risk of wound infection, transfusion, readmission, reoperation, internal organ damage, blood loss, change in hemoglobin, or length of stay when compared with standard sterilization methods.Conclusion: Salpingectomy at the time of cesarean delivery was associated with a small increase in operative time; however, it was not associated with an increased rate of surgical complications. This option should be considered for patients desiring sterilization during cesarean delivery.Systematic Review Registration: PROSPERO, CRD42019145247. [ABSTRACT FROM AUTHOR]

Eleven genes have been identified that increase the lifetime risk of developing ovarian cancer. The cumulative cancer risk of ovarian cancer varies with the mutation type and age. Ovarian cancer risk management options include surgical risk reduction with salpingo-oophorectomy and a newer step-wise approach with interval salpingectomy and delayed oophorectomy. Women should be counseled on the pros and cons of hysterectomy in the setting of reducing the risk of other cancers; eliminating the risk of endometrial cancer in Lynch Syndrome, potential risk of serous/serous-like endometrial cancer in BRCA1 carriers, and elimination of progestogen therapy that may increase breast cancer risk. [ABSTRACT FROM AUTHOR]

For patients with a known hereditary risk of ovarian cancer, primary prevention typically is accomplished through prophylactic bilateral salpingo-oophorectomy. However, some patients may wish to preserve fertility or delay menopause and its associated comorbidities. This article discusses appropriate methods of contraception for these patients. [ABSTRACT FROM AUTHOR]

This article, "Is the pelvic examination still crucial in patients presenting to the emergency department (ED) with vaginal bleeding or abdominal pain when an intrauterine pregnancy is identified on ultrasonography? A randomized controlled trial," by J. A. Linden et al. (2017) seeks to determine whether excluding a pelvic examination among patients presenting to the ED with first-trimester vaginal bleeding or lower abdominal pain, and indication of intrauterine pregnancy recorded on ultrasound increases morbidity. The findings are discussed in the context of changing practice and patient preference. Emergency nurse practitioners should remain informed about changing practices to ensure that patients receive safe care. Although pelvic examination does provide additional information for specific clinical conditions, the current practice to always include it in the evaluation of a pregnant patient with vaginal bleeding or pelvic pain may no longer be relevant given the improved diagnostic capabilities available within the ED setting. [ABSTRACT FROM AUTHOR]

Opportunistic salpingectomy may offer obstetrician-gynecologists and other health care providers the opportunity to decrease the risk of ovarian cancer in their patients who are already undergoing pelvic surgery for benign disease. By performing salpingectomy when patients undergo an operation during which the fallopian tubes could be removed in addition to the primary surgical procedure (eg, hysterectomy), the risk of ovarian cancer is reduced. Although opportunistic salpingectomy offers the opportunity to significantly decrease the risk of ovarian cancer, it does not eliminate the risk of ovarian cancer entirely. Counseling women who are undergoing routine pelvic surgery about the risks and benefits of salpingectomy should include an informed consent discussion about the role of oophorectomy and bilateral salpingo-oophorectomy. Bilateral salpingo-oophorectomy that causes surgical menopause reduces the risk of ovarian cancer but may increase the risk of cardiovascular disease, cancer other than ovarian cancer, osteoporosis, cognitive impairment, and all-cause mortality. Salpingectomy at the time of hysterectomy or as a means of tubal sterilization appears to be safe and does not increase the risk of complications such as blood transfusions, readmissions, postoperative complications, infections, or fever compared with hysterectomy alone or tubal ligation. The risks and benefits of salpingectomy should be discussed with patients who desire permanent sterilization. Additionally, ovarian function does not appear to be affected by salpingectomy at the time of hysterectomy based on surrogate serum markers or response to in vitro fertilization. Plans to perform an opportunistic salpingectomy should not alter the intended route of hysterectomy. Obstetrician-gynecologists should continue to observe and practice minimally invasive techniques. This Committee Opinion has been updated to include new information on the benefit of salpingectomy for cancer reduction, the feasibility of salpingectomy during vaginal hysterectomy, and long-term follow-up of women after salpingectomy. [ABSTRACT FROM AUTHOR]

Objective: To estimate whether performance of salpingectomy compared with standard tubal ligation for sterilization at the time of cesarean delivery increases operating time or complication rates.Methods: A randomized controlled noninferiority trial was performed at a single academic institution. Women undergoing planned cesarean delivery who desired sterilization were randomized to salpingectomy or standard tubal ligation. The primary outcome was length of time of the sterilization procedure, with the noninferiority margin set at 5 minutes. With a one-sided independent sample t test, to achieve a power of 90% with an α of 0.05, 18 women needed to complete each intervention.Results: Forty-four women were enrolled, with 19 successfully undergoing salpingectomy and 18 undergoing standard tubal ligation. Salpingectomy could not be completed in 1 of 20 patients (as a result of adhesions). Baseline demographics were equivalent between groups. Salpingectomy procedure time was noninferior to standard tubal ligation, with a mean difference of 0.5 minutes, with a mean sterilization procedure time of 5.6 minutes in the salpingectomy group and 6.1 minutes in the standard tubal ligation group (P <.05, one-sided 95% CI upper bound 1.8 minutes). There was no difference between cesarean delivery with salpingectomy compared with cesarean delivery with standard tubal ligation in median total operating time (60 vs 68 minutes, P=.34) or estimated blood loss (600 vs 700 mL, P=.09). No patients in either group required reoperation or readmission.Conclusion: Salpingectomy procedure time was not longer than standard tubal ligation during cesarean delivery, with a mean difference of 30 seconds. There was a high completion rate for salpingectomy (95%) and no apparent increase in complications.Clinical Trial Registration: Clinicaltrials.gov, NCT03028623. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the feasibility of salpingectomy compared with standard bilateral tubal ligation at the time of cesarean delivery in women with undesired fertility.Methods: We included women at 35 weeks of gestation or greater desiring permanent sterilization at the time of cesarean delivery. Patients were randomized after skin incision to bilateral salpingectomy or bilateral tubal ligation by a computer-generated scheme. If salpingectomy could not be completed on one or both sides, bilateral tubal ligation was attempted. Primary feasibility outcomes were total operative time and bilateral completion of the randomized procedure. Secondary outcomes included clinically estimated blood loss and surgical complications up to 6 weeks postpartum. We estimated that 80 patients (40 per group) would provide greater than 80% power to identify a 10-minute difference in the primary outcome (time) with a SD of 15 minutes and a two-sided α of 0.05. Analysis was by intent to treat.Results: Of 221 women screened from June 2015 to April 2017, 115 (52%) consented to the study; 80 were randomized-40 to salpingectomy and 40 to bilateral tubal ligation. Groups were similar at baseline. A total of 27 bilateral salpingectomies were successfully completed compared with 38 bilateral tubal ligations (68% compared with 95%, P=.002). Total operative time was on average 15 minutes longer for salpingectomies (75.4±29.1 compared with 60.0±23.3 minutes, P=.004). No adverse outcomes directly related to the sterilization procedure were noted in either group. Although estimated blood loss of only the sterilization procedure (surgeon estimate) was greater for the salpingectomy group (median 10 [interquartile range 5-25] compared with 5 [interquartile range 5-10] cc, P<.001), total estimated blood loss and safety outcomes were similar for both groups.Conclusion: Adding 15 minutes to total operative times, salpingectomy can be successfully completed in approximately two thirds of women desiring permanent contraception with cesarean delivery.Clinical Trial Registration: Clinicaltrials.gov, NCT02374827. [ABSTRACT FROM AUTHOR]

There has been much progress in ovarian cancer screening and prevention in recent years. Improved tools that combine genetic and epidemiologic factors to predict an individual's ovarian cancer risk are set to become available for tailoring preventive and screening approaches. The increasing evidence on tubal origins of a proportion of ovarian cancer has paved the way to use of opportunistic bilateral salpingectomy at tubal ligation and hysterectomy in the general population. Clinical trials are in progress to estimate the long-term effects on endocrine function. In women at high risk, risk reducing salpingo-oophorectomy remains the standard of care with the current focus on management of resulting noncancer outcomes, especially sexual dysfunction in younger women. This has led to evaluation of early bilateral salpingectomy and delayed oophorectomy in this population. Meanwhile, modeling suggests that BRCA mutation carriers should consider using the oral contraceptive pill for chemoprevention. In the general population, the largest ovarian cancer screening trial to date, the UK Collaborative Trial of Ovarian Cancer Screening reported a stage shift with annual multimodal screening using the longitudinal CA 125 Risk of Ovarian Cancer Algorithm but not with annual transvaginal ultrasound screening. There was no definitive mortality reduction with either screening strategy compared with no screening. Further follow-up until December 2018 in now underway. Stage shift and higher rates of optimal cytoreduction were also reported during 3- to 4-monthly multimodal screening in the United Kingdom and U.S. high-risk screening trials. Although all agree that there is not yet evidence to support general population screening, recommendations for high-risk screening vary between countries. A key finding from the screening trials has been the better performance of longitudinal algorithms compared with a single cutoff for CA 125. A major focus of ovarian cancer biomarker discovery work has been tumor DNA markers in both plasma and novel specimens such as cervical cytology samples. [ABSTRACT FROM AUTHOR]

Objectives: In women receiving sterilization, the removal of the entire fallopian tube, a procedure referred to as a risk-reducing salpingectomy (RRS), reduces subsequent ovarian cancer risk compared with standard tubal sterilization procedures. There are limited data on which surgical procedure women will choose when educated about the benefits of an RRS. Our objective was to study the proportion of women desiring sterilization that would choose an RRS.Methods: This cohort study included women 30 years of age and older with a living biological child who requested laparoscopic sterilization at a tertiary academic hospital. Participants were given a decision aid and offered an RRS or a standard tubal sterilization procedure with titanium clips. The primary outcome was to determine the proportion of women who would choose an RRS. Other outcomes included estimated blood loss and operative time, which was compared between groups, along with complications.Results: Fourteen of the 18 (78%) women who participated in our study chose RRS. Estimated blood loss and operating time were similar among women who underwent RRS and standard tubal sterilizations. There were no significant complications in either group. The study was ended early based on emerging data and a change in national practice patterns.Conclusions: Because of the elective nature of sterilization and the complexities of cancer risk reduction, a patient-centered approach is beneficial for sterilization counseling. Our results support offering RRS as an alternative to standard tubal sterilization. [ABSTRACT FROM AUTHOR]

Female sterilization is relied on by nearly one in three women aged 35-44 years in the United States. Sterilization procedures are among the most common procedures that obstetrician-gynecologists perform. The most frequent sterilization procedures include postpartum tubal ligation, laparoscopic tubal disruption or salpingectomy, and hysteroscopic tubal occlusion. The informed consent process for sterilization is crucial and requires shared decision-making between the patient and the health care provider. Counseling should include the specific risks and benefits of the specific surgical approaches. Additionally, women should be counseled on the alternatives to sterilization, including intrauterine contraceptives and subdermal contraceptive implants. Complications, including unplanned pregnancy after successful female sterilization, are rare. The objectives of this Clinical Expert Series are to describe the epidemiology of female sterilization, access to postpartum sterilization, advances in interval sterilization techniques, and clinical considerations in caring for women requesting sterilization. [ABSTRACT FROM AUTHOR]

Preclinical models are relatively underutilized and underfunded resources for modeling the pathogenesis and prevention of ovarian cancers. Several reviews have detailed the numerous published models of ovarian cancer. In this review, we will provide an overview of experimental model systems, their strengths and limitations, and use selected models to illustrate how they can be used to address specific issues about ovarian cancer pathogenesis. We will then highlight some of the preclinical prevention studies performed to date and discuss experiments needed to address important unanswered questions about ovarian cancer prevention strategies. [ABSTRACT FROM AUTHOR]

Ovarian carcinoma is the most lethal malignancy of the female genital tract. Population-based trials in the general population have not demonstrated that screening improves early detection or survival. Therefore, application of prevention strategies is vital to improving outcomes from this disease. Surgical prevention reduces risk and prophylactic risk-reducing salpingo-oophorectomy is the most effective means to prevent ovarian carcinoma in the high-risk patient although the risks do not outweigh the benefits in average risk patients. Other surgical and medical options have unknown or limited efficacy in the high-risk patient. In this review, we define the patient at high risk for ovarian cancer, discuss how to identify these women and weigh their available ovarian cancer prevention strategies. [ABSTRACT FROM AUTHOR]

Ovarian cancer remains to be the most lethal of all gynecologic malignancies. There is no effective screening test proven to reduce the mortality associated with this disease. Costs of treating ovarian cancer are substantial and among the highest of all cancer types. Therefore, it is essential to pursue strategies to prevent ovarian cancer that are cost-effective in the context of our health care system. There are 2 subgroups of women for whom ovarian cancer prevention strategies have been evaluated for effectiveness and costs: (1) general population at risk, and (2) BRCA mutation carriers with a high lifetime risk. Key words: opportunistic salpingectomy, BRCA mutation, risk-reducing salpingo-oophorectomy, prophylactic salpingectomy with delayed oophorectomy, high-grade serous carcinoma, triple negative breast cancer [ABSTRACT FROM AUTHOR]

Serous tubal intraepithelial carcinoma is considered the precursor lesion of high-grade serous carcinoma, and found in both low-risk and high-risk populations. Isolated serous tubal intraepithelial carcinomas in patients with BRCA1/2 mutations are detected in -2% of patients undergoing risk-reducing bilateral salpingo-oophorectomy and even with removal of the tubes and ovaries the rate of developing primary peritoneal carcinoma following remains up to 7.5%. Postoperative recommendations after finding incidental STICs remain unclear and surgical staging, adjuvant chemotherapy, or observation have been proposed. Discovery of STIC should prompt consideration of hereditary cancer program referral for BRCA1/2 mutation screening. [ABSTRACT FROM AUTHOR]

Lack of success in ovarian cancer control through screening or advances in treatment in the general population has prompted exploration in new avenues of prevention. "Opportunistic" salpingectomy describes a surgical procedure or risk-reducing intent in women at low-risk/general population risk for developing ovarian cancer who are undergoing pelvic/abdominal surgery for other indications. This chapter reviews the uptake, safety, and anticipated impact of this prevention initiative. [ABSTRACT FROM AUTHOR]

In the absence of significant benefit from either novel therapeutics or screening, the focus of decreasing ovarian cancer incidence and mortality has shifted toward primary prevention. Histopathologic data have demonstrated that up to 70% of ovarian cancers may actually arise from the fallopian tube. This has led to the increased adoption of opportunistic salpingectomy as a tool for ovarian cancer prevention. In turn, the potential surgical risks and ovarian cancer prevention of this emerging practice have generated multiple studies. In this comprehensive review, we address the origins of ovarian cancer, the historical context and recent trends of tubal surgery, the existing population-based data on ovarian cancer risk reduction, and provide a detailed review of the evidence on surgical risks of salpingectomy. To date, the safety and ovarian cancer risk reduction evidence sheds a positive light on opportunistic salpingectomy. Although research on this subject has grown substantially in recent years, there remains a paucity of large, prospective studies that examine clinical outcomes. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Our objective was to evaluate whether implementing a standardized patient–physician counseling and documentation process about pain and opioid use after laparoscopic bilateral salpingectomy (LSC BS) decreased opioid prescribing. METHODS: In this study, we evaluated a quality improvement project aimed at decreasing opioid overprescribing and promoting patient–physician conversations and documentation surrounding pain control after surgery. An electronic medical record (EMR) standardized smart phrase was implemented in the Resident GYN Specialty Clinic at the Obstetrics and Gynecology Care Center in order to standardize patient–physician counseling and documentation about postoperative pain, opioid use, storage, and disposal, providing written and verbal education at the time of preoperative and postoperative appointments for Lap BS. We collected EMR data from patients who had a LSC BS preintervention (January 2019 to December 9, 2020) and postimplementation (March 2021 to October 2022). To have 90% power to detect a 25% reduction in morphine milligram equivalents (MMEs) from preimplementation to postimplementation, we needed 78 patients per group. RESULTS: A total of 78 patients met inclusion criteria for both groups. Patients postintervention were prescribed significantly fewer opioids (58.3 versus 31.35 MME, P <.001, or 7.8 versus 4.2 oxycodone 5 mg tablets) compared to patients preintervention. Significant differences were also seen in secondary outcomes with increased documentation of discussion surrounding the addictive properties of opioids and expected pain postoperatively postintervention compared to preintervention. CONCLUSION: Implementation of physician education combined with EMR prompts decreased the amount of opioids prescribed and increased documentation of patient–physician communication about safe opioid use and pain control. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Hormonal treatment is a critical aspect of health care for transgender and nonbinary patients, but scientific literature describing ovarian and uterine histopathology in the setting of testosterone therapy remains limited and conflicted. METHODS: After IRB approval and patient consent, uterine and ovarian histopathology was prospectively evaluated in 22 gender-diverse patients on testosterone compared with 21 premenopausal cisgender controls not on hormones undergoing hysterectomy. RESULTS: Average duration of testosterone administration was 54.9 months. Average age was 30 years in the testosterone group and 40.6 years in the control group. Average body mass index was 28 kg/m2 in the testosterone group and 31 kg/m2 in the control group. 18 (82%) patients in the testosterone group had inactive/atrophic endometria, compared with 2 (10%) in the control group. 4 (18%) patients in the testosterone group had proliferative endometria, compared to 10 (48%) in the control group. No patients on testosterone had secretory endometrium, compared to 6 (29%) in the control group. Leiomyoma were noted for 5 (23%) in the testosterone group and 4 (19%) in the control group. Adenomyosis was present in 1 (5%) in the testosterone group, compared to 5 (24%) in the control group. Low rates of preoperative cervical dysplasia were reported in both groups. All cervical and fallopian tube specimens in both groups were benign. CONCLUSION: Compared to a cisgender control group, patients on long-term testosterone therapy were more likely to have inactive/atrophic endometrium. Increasing our knowledge of the effects of testosterone has implications for preoperative surgical assessment and surveillance for patients not undergoing surgery. [ABSTRACT FROM AUTHOR]

In addressing the main critique, van der Schouw et al[2] studied only timing and cause of menopause and did not assess those who had oophorectomy after they had undergone menopause for any other reason. With regard to reoperation rates, Parker et al cite a 1996 study that shows rates lower than others reported when oophorectomy was more common with hysterectomy. The tubal origin theory posits that high-grade serous ovarian cancer risk might be mitigated by opportunistic salpingectomy, developed from observations in patients at high risk for ovarian cancer. [Extracted from the article]

We derived 6% from Table 4 of a van der Schouw study showing increased risk specifically due to oophorectomy.[3] The 2% risk used by Rush et al included women predominantly having natural menopause, a distinctly different biologic process. We appreciate the interest in our article in the May 2022 issue about the Markov model showing the benefit of ovarian conservation during hysterectomy for benign disease.[[1]] Rush et al disagree with our analysis based on a 6% increased risk of cardiovascular disease for each year of earlier menopause. [Extracted from the article]

The authors appreciate the insightful comments by Dr. Peter Rose. We agree that ovarian cancer histology has a significant effect on prognosis. However, our current study obtained ancillary data from Gynecologic Oncology Group 157, a randomized clinical trial evaluating the benefit of three cycles compared with six cycles of chemotherapy in high-risk, early-stage cancers. [Extracted from the article]

Rationale: Sex cord-stromal tumors are always found in ovary, but the occurrence of this kind of tumor at extraovarian locations is extremely rare. Up to now, the case concerning fibrothecoma of broad ligament with minor sex cord elements has not been reported, and it is extremely challenging to diagnose before surgery. In this case report, we summarized pathogenesis, clinical features, laboratory finding, imaging studies, pathology, and therapeutic schedule of this tumor, with the aim of raising awareness and attention to this type of disease., Patient Concerns: A 45-year-old Chinese woman was referred to our department with intermittent lower abdominal pain for about 6 years. On examination, both ultrasonography and computed tomography revealed she had a right adnexal mass., Diagnosis: Based on the results of histology and immunohistochemistry, the final diagnosis was confirmed as fibrothecoma of broad ligament with minor sex cord elements., Interventions: This patient underwent laparoscopic unilateral salpingo-oophorectomy with excision of the neoplasm., Outcomes: Eleven days post-treatment, the patient complained that the symptoms of abdominal pain was disappeared. There is no evidence of disease recurrence 5 years after laparoscopic surgery according to the consequences of radiologic examination., Conclusion: The natural history of this kind of tumor is uncertain. Although main treatment of this neoplasm might be surgical resection and good prognosis can be achieved, we believe that long-time follow-up is extremely important in all patients diagnosed as fibrothecoma of broad ligament with minor sex cord. Laparoscopic unilateral salpingo-oophorectomy with excision of the tumor should be recommended to these patients., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: To compare the long-term risks associated with salpingo-oophorectomy with ovarian conservation at the time of benign hysterectomy.Data Sources: MEDLINE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials were searched from inception to January 30, 2015. We included prospective and retrospective comparative studies of women with benign hysterectomy who had either bilateral salpingo-oophorectomy (BSO) or conservation of one or both ovaries.Methods Of Study Selection: Reviewers double-screened 5,568 citations and extracted eligible studies into customized forms. Twenty-six comparative studies met inclusion criteria. Studies were assessed for results, quality, and strength of evidence.Tabulation, Integration, and Results: Studies were extracted for participant, intervention, comparator, and outcomes data. When compared with hysterectomy with BSO, prevalence of reoperation and ovarian cancer was higher in women with ovarian conservation (ovarian cancer risk of 0.14-0.7% compared with 0.02-0.04% among those with BSO). Hysterectomy with BSO was associated with a lower incidence of breast and total cancer, but no difference in the incidence of cancer mortality was found when compared with ovarian conservation. All-cause mortality was higher in women younger than age 45 years at the time of BSO who were not treated with estrogen replacement therapy (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.04-1.92). Coronary heart disease (HR 1.26, 95% CI 1.04-1.54) and cardiovascular death were higher among women with BSO (HR 1.84, 95% CI 1.27-2.68), especially women younger than 45 years who were not treated with estrogen. Finally, there was an increase in the prevalence of dementia and Parkinson disease among women with BSO compared with conservation, especially in women younger than age 50 years. Clinical practice guidelines were devised based on these results.Conclusion: Bilateral salpingo-oophorectomy offers the advantage of effectively eliminating the risk of ovarian cancer and reoperation but can be detrimental to other aspects of health, especially among women younger than age 45 years. [ABSTRACT FROM AUTHOR]

Background: Vaginal hysterectomy is the preferred route of hysterectomy in benign gynecologic disease; however, a vaginal salpingo-oophorectomy can sometimes be technically challenging. Even the most skilled vaginal surgeon will occasionally have to convert to an abdominal approach to complete the procedure.Technique: After a vaginal hysterectomy, if the surgeon is struggling to safely complete a salpingo-oophorectomy, a natural orifice transluminal endoscopic surgery (NOTES) approach could be considered. A single port is placed in the vagina and after achieving pneumoperitoneum, an endoscope is introduced to perform a survey of the pelvis and lower abdomen. The salpingo-oophorectomy can then be completed under direct visualization by using conventional laparoscopic instruments through the vaginal port.Experience: Salpingo-oophorectomy was successfully completed in six unembalmed cadavers and in two live patients.Conclusion: At the time of difficult vaginal salpingo-oophorectomy, the use of a NOTES approach could circumvent the need to convert to an abdominal route. It provides clear visualization of the entire pelvic and abdominal area and is technically feasible. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the trend in uptake of salpingectomy at the time of hysterectomy and assess physicians' attitudes toward the practice.Methods: This was a retrospective cohort study using the electronic medical record to identify women 18 years of age or older undergoing hysterectomy from June 2011 to May 2014 in a large integrated health care delivery system. The primary outcome was the change in rate of opportunistic salpingectomy over time and after a systemwide practice recommendation was issued in May 2013. Secondary outcomes included data on blood loss, operating time, and length of stay.Results: Of the 12,143 hysterectomies performed over the 3-year study period, 7,498 were performed without oophorectomy. There was a statistically significant rise in rate of salpingectomy over time from 14.7% for June 2011 to May 2012 to 44.6% from June 2012 to May 2013 and to 72.7% from June 2013 to May 2014 (P<.001). Sixty-one percent of laparoscopic hysterectomies were performed with salpingectomy, whereas only 25% of abdominal and 17% of vaginal hysterectomies had salpingectomies. Median estimated blood loss was lower in the salpingectomy group, 100 compared with 150 mL (P<.01). There was a significantly shorter median operating time (147 compared with 154 minutes, P=.002) for laparoscopic hysterectomy with bilateral salpingectomy compared with laparoscopic hysterectomy alone.Conclusion: Rates of salpingectomy increased significantly over time, consistent with the high reported acceptance rate reported by health care providers and highlighting the importance of physician education to improve compliance with risk-reducing clinical strategies. [ABSTRACT FROM AUTHOR]

Objective: To estimate BRCA1/2 mutation carriers' cumulative ovarian cancer risks after risk-reducing salpingectomy at various ages with delayed oophorectomy several years later compared with risk-reducing salpingo-oophorectomy.Methods: A literature search was performed on cumulative ovarian cancer risks and effects of risk-reducing salpingo-oophorectomy and salpingectomy. Results were used in a modeling study to estimate cumulative ovarian cancer risks for various scenarios of salpingectomy with delayed oophorectomy and risk-reducing salpingo-oophorectomy using Cox proportional hazard models.Results: Estimated cumulative ovarian cancer risks at age 70 years for risk-reducing salpingectomy with delayed oophorectomy are highest for BRCA1 mutation carriers undergoing surgeries at higher age. Maximum increase in point estimates (from 1.8% to 4.1%) occurs in 40-year-old BRCA1 mutation carriers undergoing oophorectomy at age 45 years after nonprotective salpingectomy instead of salpingo-oophorectomy at age 40 years. In the best-case scenario, assuming 65% risk reduction by salpingectomy and 96% by salpingo-oophorectomy, point estimates increase (from 1.8% to 2.6%) or decrease (from 3.4% to 3.3%) depending on age. In the worst-case scenario for BRCA2, point estimates maximally increase from 0.6% to 1.8% in 45-year-old carriers when oophorectomy is performed at age 50 years instead of risk-reducing salpingo-oophorectomy at age 45 years. In the best-case scenario, point estimates increase (from 1.3% to 1.5%) or decrease (from 1.5 to 1.3%).Conclusion: Differences in estimated ovarian cancer risks between risk-reducing salpingo-oophorectomy and salpingectomy with delayed oophorectomy are small, even if salpingectomy is ineffective. Presented estimated ovarian cancer risks can be used in counseling BRCA1/2 mutation carriers, thereby facilitating a personalized and well-informed choice for either strategy. [ABSTRACT FROM AUTHOR]

Objective: To examine hospital variation in the practice of bilateral salpingectomy with ovarian conservation at the time of benign hysterectomy.Methods: We conducted a cross-sectional study using data from the 2012 National Inpatient Sample. We identified hospitalizations for benign, nonobstetric hysterectomy in adult women and excluded women who had elevated risk for ovarian cancer or a subsequent operation of the ovary. Of the remaining sample, we calculated the rate of bilateral salpingectomy with ovarian conservation for each hospital and conducted multivariable regression analysis to identify factors associated with a hospital's practice of this procedure.Results: There were 63,306 hospitalizations for hysterectomy, and 20,635 were for adult women at low risk for ovarian cancer or subsequent ovarian surgery. Among these low-risk women, only 5.9% (95% confidence interval 5.4-6.5%) received bilateral salpingectomy with ovarian conservation. The rate varied markedly across 744 hospitals in the United States ranging from 0% to 72.2%. At 376 of the hospitals (50.5%), no low-risk women received bilateral salpingectomy with ovarian conservation. When categorizing hospitals into tertiles based on the proportion of their hysterectomies performed laparoscopically, hospitals in the highest tertile were more likely to have low-risk patients undergoing bilateral salpingectomy with ovarian conservation than those in the lowest tertile (adjusted odds ratio 2.343, P=.02). Geographic region, hysterectomy volume, and proportion of white patients were also significantly associated with a hospital's likelihood of having low-risk patients undergoing this procedure.Conclusion: The rate of bilateral salpingectomy with ovarian conservation was low in low-risk women undergoing benign hysterectomies. Hospitals varied widely in their practice. [ABSTRACT FROM AUTHOR]

Background: The vaginal surgeon is challenged with performing complex procedures within a surgical field of limited light and exposure.Instrument: The video telescopic operating microscope is an illumination and imaging system that provides visualization during open surgical procedures with a limited field of view. The imaging system is positioned within the surgical field and then secured to the operating room table with a maneuverable holding arm. A high-definition camera and Xenon light source allow transmission of the magnified image to a high-definition monitor in the operating room. The monitor screen is positioned above the patient for the surgeon and assistants to view real time throughout the operation.Experience: The video telescopic operating microscope system was used to provide surgical illumination and magnification during total vaginal hysterectomy and salpingectomy, midurethral sling, and release of vaginal scar procedures. All procedures were completed without complications. The video telescopic operating microscope provided illumination of the vaginal operative field and display of the magnified image onto high-definition monitors in the operating room for the surgeon and staff to simultaneously view the procedures.Conclusion: The video telescopic operating microscope provides high-definition display, magnification, and illumination during vaginal surgery. [ABSTRACT FROM AUTHOR]

Background: Opportunistic salpingectomy at the time of hysterectomy is currently recommended to reduce the lifetime risk of ovarian cancer. The vaginal route is least invasive, but surgeons sometimes may choose to perform this procedure laparoscopically or robotically when anticipating adnexal surgery as a result of limited visibility.Technique: We describe a surgical technique to make salpingectomy by the vaginal route easier and more feasible. Posterior rotation of the uterus provides excellent access to the tube, which can easily be removed before separation of the adnexa.Experience: We have performed more than 60 vaginal hysterectomies using this technique. Salpingectomy was always feasible.Conclusion: We demonstrate a simple technique to safely perform opportunistic salpingectomy during a vaginal hysterectomy. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To conduct a cost-effectiveness analysis of opportunistic salpingectomy (elective salpingectomy at hysterectomy or instead of tubal ligation). METHODS: A Markov Monte Carlo simulation model estimated the costs and benefits of opportunistic salpingectomy in a hypothetical cohort of women undergoing hysterectomy for benign gynecologic conditions or surgical sterilization. The primary outcome measure was the incremental cost-effectiveness ratio. Effectiveness was measured in terms of life expectancy gain. Sensitivity analyses accounted for uncertainty around various parameters. Monte Carlo simulation estimated the number of ovarian cancer cases associated with each strategy in the Canadian population. RESULTS: Salpingectomy with hysterectomy was less costly ($11,044.32±$1.56) than hysterectomy alone ($11,206.52±$29.81) or with bilateral salpingo-oophorectomy ($12,626.84±$13.11) but more effective at 21.12±0.02 years compared with 21.10±0.03 and 20.94±0.03 years, representing average gains of 1 week and 2 months, respectively. For surgical sterilization, salpingectomy was more costly ($9,719.52±$3.74) than tubal ligation ($9,339.48±$26.74) but more effective at 22.45±0.02 years compared with 22.4360.02 years (average gain of 1 week) with an incremental cost-effectiveness ratio of $27,278 per year of life gained. Our results were stable over a wide range of costs and risk estimates. Monte Carlo simulation predicted that salpingectomy would reduce ovarian cancer risk by 38.1% (95% confidence interval [CI] 36.5-41.3%) and 29.2% (95% CI 28.0-31.4%) compared with hysterectomy alone or tubal ligation, respectively. CONCLUSION: Salpingectomy with hysterectomy for benign conditions will reduce ovarian cancer risk at acceptable cost and is a cost-effective alternative to tubal ligation for sterilization. Opportunistic salpingectomy should be considered for all women undergoing these surgical procedures. [ABSTRACT FROM AUTHOR]

Rationale: Heterotopic pregnancy (HP) is defined as the simultaneous presence of intrauterine pregnancy and ectopic pregnancy (EP). HP after bilateral salpingectomy is extremely rare and may lead to serious complications if it is misdiagnosed and untreated timely. Here, we presented the first reported case of uterine serosal HP in a woman after assisted reproductive technology with bilateral salpingectomy because of bilateral tubal ectopic pregnancy., Patient Concerns: A 27-years-old pregnant woman after in vitro fertilization with bilateral salpingectomy complained of a sudden onset of unprovoked abdominal pain, which was persistent and dull. She denied vaginal bleeding., Diagnoses: Serum beta-human chorionic gonadotropin levels are difficult to predict HP. Transvaginal ultrasonography demonstrated 1 gestational sac in the uterine cavity and 1 thick-walled cystic mass over the upper of the uterus, with a large amount of fluid in the Pouch of Douglas. Emergency laparotomy revealed a uterine serosal pregnancy combined with intrauterine pregnancy., Interventions: This patient was successfully managed via emergency laparotomy to remove residual tissue and repair the rupture of the uterine serosal pregnancy., Outcomes: At postoperative 4 days, repeat transvaginal ultrosonography presented 1 intrauterine gestational sac with a visible fetal bud and cardiac tube pulsation. Now the patient recover well and is in an ongoing pregnancy., Lessons: It is noteworthy that HP/ectopic pregnancy is still not prevented after bilateral salpingectomy. In cases of multiple embryo transfer, even if intrauterine pregnancy has been established, it is important to rule out HP/ectopic pregnancy in time. Early diagnosis and early management can significantly improve clinical outcomes., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

INTRODUCTION: Opportunistic salpingectomy at the time of benign gynecologic surgery and cesarean delivery is a cost-effective strategy for ovarian cancer risk reduction. We sought to evaluate the cost-effectiveness of opportunistic salpingectomy compared to standard tubal ligation in the immediate postpartum period following vaginal deliveries. METHODS: Using two decision analytic models, we simulated a hypothetical cohort of 10,000 women undergoing bilateral salpingectomy or tubal ligation immediately following vaginal delivery. We derived probabilities of ovarian cancer risk reduction following tubal sterilization from published literature. We used institutional charge data to determine cost inputs. The primary outcome was the incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) at a cost-effectiveness threshold of $100,000/QALY. Institutional review board (IRB) approval was obtained. RESULTS: Opportunistic salpingectomy is more cost-effective than tubal ligation following vaginal delivery in a theoretical cohort, with an ICER of $24,176/QALY. Compared to tubal ligation, opportunistic salpingectomy yields a theoretical total cost savings of $6.48 million. Discounted costs of ovarian cancer were $2.9 million lower for the salpingectomy cohort compared to tubal ligation. Opportunistic salpingectomy avoided 12 fewer ovarian cancer cases and 8 fewer ovarian cancer deaths compared to tubal ligation. CONCLUSION: Our analytic model demonstrates that following vaginal delivery, opportunistic salpingectomy is a cost-effective strategy for reducing risk of ovarian cancer. Compared to tubal ligation, opportunistic salpingectomy reduces ovarian cancer cases and mortality. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Previous literature in obstetrics has shown that racial biases influence postpartum pain management. Little is known about how these preconceptions affect opioid prescriptions in a post-operative setting. We compared the amount of morphine milligram equivalents (MME) prescribed to patients who identify as White and Black after a laparoscopic bilateral salpingectomy. METHODS: We conducted a retrospective chart review of 399 patients who underwent outpatient laparoscopic bilateral salpingectomies at Bronson Methodist Hospital in Kalamazoo between 2016 and 2021. Mean MMEs prescribed after surgery and maximum pain scores were compared between patients who identify as Black and White. Two-sided t-test was used to evaluate the data (significance at alpha 0.05). Maximum pain scores were calculated with the Mann-Whitney U test. RESULTS: 25.8% (103/399) of our patient population self-identified as Black and 74.2% as White. The most commonly prescribed discharge pain medication for both groups was hydrocodone/acetaminophen, 55.6% and 51.7%, respectively. The median of max pain score (scale 0-10) of both groups was 6 (P =.63). The mean MME for White patients (n=256) was 37.6 (SD 14.7), while that of Black patients (n= 88) was 39.4 (17.4) with a P -value.3295. There was not a significant difference in pain scores by race within the first or last quartiles either. CONCLUSION: Our work serves as a model that clinical practices can utilize to evaluate current pain prescription practices and identify racial bias in pain management at an institutional level. Future studies with larger sample sizes are warranted to further explore this relationship. [ABSTRACT FROM AUTHOR]

The article discusses impact on future fertility after medical or surgical management of ectopic pregnancy. It necessitates proper diagnosis in selection of suitable candidates, and avoidance of tubal damage to preserve tubal function and reproductive potential. It discusses expectant, medical and surgical management, suggesting laparoscopic salpingostomy and salpingectomy as ideal means of surgical removal of ectopic pregnancies, and medical management as a safe alternative to surgery.

The article discusses surgical management as an effective and important treatment modality for ectopic pregnancy, and laparoscopy as a commonly used method of access. It also highlights the need of individualized approach to determine surgical method, considering, risk of recurrent trophoblastic disease, chance of completing the surgery and desire for future child bearing. The procedures of salpingostomy, salpingectomy and other surgical options for non-tubal ectopic pregnancies are discussed.

The article discusses several strategies for the treatment of the increasing trend of ectopic pregnancy incidence in the U.S. It mentions that more than 100,000 of the annual 6 million pregnancies in the country are considered ectopic pregnancies. Accordingly, it led to the development of innovative surgical and nonsurgical treatment such as expectant, methotrexate, and surgery depending upon the location of the ectopic pregnancy. Surgical operations for specific locations are also discussed.

The article offers information about ectopic pregnancy. It is a major gynecologic emergency resulting from significant morbidity for the mother and inevitable loss of the pregnancy. It can be varied from minor symptoms to sudden collapse. Also, it produces a diagnostic dilemma and a management problem. However, through advances in medical care, most women will survive and will be diagnosed early to allow conservative management with resulting lower morbidity and possible anatomic conservation.

Ovarian cancer has the highest mortality rate out of all types of gynecologic cancer and is the fifth leading cause of cancer deaths among women. Current attempts at screening for ovarian cancer have been unsuccessful and are associated with false-positive test results that lead to unnecessary surgery and surgical complications. Prophylactic salpingectomy may offer clinicians the opportunity to prevent ovarian cancer in their patients. Randomized controlled trials are needed to support the validity of this approach to reduce the incidence of ovarian cancer. The approach to hysterectomy or sterilization should not be influenced by the theoretical benefit of salpingectomy. Surgeons should continue to observe and practice minimally invasive techniques. [ABSTRACT FROM AUTHOR]