Proposal of risk-reducing salpingo-oophorectomy using hybrid vaginal natural orifice transluminal endoscopic surgery (vNOTEs)

Abstract

　RRSO is recommended for individuals with BRCA pathogenic variants within a certain age range. Conventional transvaginal natural orifice endoscopic surgery (vNOTEs) cannot detect the presence of peritoneal dissemination in the pouch of Douglas or minimal ascites prior to scope insertion. Considering the possibility of incidental peritoneal dissemination in the pouch of Douglas, applying conventional vNOTEs directly to RRSO is deemed unsafe. Furthermore, it does not allow for detailed observation within the abdominal cavity. In our study, we performed RRSO on female BRCA1 pathogenic variant carriers using a hybrid vNOTEs approach. This involved inserting a flexible scope through a 5mm port inserted from the pouch of Douglas, a 12mm port at the umbilicus, and a direct insertion of a 2.4mm diameter trocarless grasping forceps at the lower midline of the abdomen. Our proposed hybrid vNOTEs approach for RRSO offers excellent postoperative pain control, cosmetic outcomes, and enables the necessary surgical manipulations required for RRSO.