Opportunistic Salpingectomy at the Time of Cesarean Delivery

High-grade serous ovarian cancer is the most common and lethal form of ovarian cancer, responsible for up to 80% of ovarian cancer-related deaths. Current screening methods are ineffective, and most patients present with advanced disease. Evidence shows that many cases originate in the distal fallopian tube rather than the ovary itself, prompting adoption of opportunistic salpingectomy during gynecologic surgery to reduce ovarian cancer risk. Cesarean delivery, one of the most commonly performed surgeries globally, provides a valuable opportunity to offer salpingectomy to patients already undergoing abdominal surgery, reducing future ovarian cancer risk without an additional procedure.

After fetal delivery and uterine closure, the uterus is exteriorized to improve access. The fallopian tubes are gently compressed to relieve vascular congestion and elevated with atraumatic graspers, then windows are created within the avascular spaces of the mesosalpinx using monopolar electrocautery. Skeletonized vessels are coagulated and transected, and the remaining pedicles are clamped, transected, and suture ligated. Complete removal of both tubes, including the fimbriae, is performed. Specimens are sent to pathology, and the cesarean closure proceeds in the usual fashion.

At our institution, opportunistic salpingectomy is offered to patients undergoing cesarean delivery who have completed childbearing. Prenatal counseling addresses the procedure's benefits, risks, and permanent nature. In our experience, it adds 7-10 minutes of operative time without increasing blood loss, infection, or hospital stay.

Opportunistic salpingectomy at cesarean delivery is a safe and feasible evidence-based strategy to reduce ovarian cancer risk. With appropriate technique, counseling, and patient selection, opportunistic salpingectomy at cesarean delivery provides a valuable risk-reduction opportunity during an already indicated procedure.