(3) The mesosalpinx is grasped with Kelly hemostats and divided with the
suspensory ligament of the ovary.
(4) The cornual attachment of the tube is excised with a knife or curved
scissors. Bleeding vessels are controlled with suture ligatures.
(5) The edges of the broad ligament are peritonealized from the uterine horn
to the infundibulopelvic ligament, as for hysterectomy.
(6) The wound is closed as for laparotomy; dressings are applied and held
in place with adhesive or plastic tape.
2-42. SALPINGOSTOMY (TUBAL PLASTY)
a. General. This operation involves the removal of the obstructed portion of the
tube and suspension of the remaining portion to the side of the pelvic wall or placement
of it into the uterine cavity. These procedures are for the purpose of restoring fertility.
b. Operative Procedure. One of several techniques is carried out after
salpingectomy has been performed. The Estes technique or some modification of it is
usually followed. In the Estes technique, the convex surface of the ovary is excised and
implantation of the remainder is made in the myometrium, communicating with the
2-43. TUBAL LIGATION
(1) This operation is the interruption of fallopian tube continuity, resulting in
sterilization of the patient. In general, the indications for sterilization can be divided into
three groups: psychiatric, medical, and obstetrical and gynecological. Evaluation and
recommendation of sterilization is made by the attending physician. A sterilization
permit and a procedure consent form must be signed by both the husband and wife.
(2) The optimum time for sterilization is approximately 24 hours after vaginal
delivery, but an objection to this is that the danger of hemorrhage still exists soon after
delivery. If a cesarean section is done, the tubes are ligated at this time; with a normal
delivery, tubal ligation is done on the first to third postpartum day.
b. Patient Preparation. The patient is placed in a supine position and a
catheter placed in the bladder. Skin prep and draping is as for laparotomy.
c. Operative Procedure.
(1) The location of the fundus is determined, and a midline incision is made
approximately 2 inches below it. The abdomen is opened in the usual manner.