Single-port risk-reducing salpingo-oophorectomy with and without hysterectomy: Surgical outcomes and learning curve analysis
Introduction
Based on considerable prospective data, risk-reducing salpingo-oophorectomy (RRSO) is one of the most beneficial interventions available to reduce ovarian/breast cancer risk in BRCA carriers and high-risk women. In many of these women, RRSO with and without hysterectomy may be performed via a minimally invasive approach [1], [2]. Characteristically, major laparoscopic surgery involves the use of three to four 5-mm and/or 12-mm ports inserted through skin incisions to have the necessary tissue retraction and triangulation essential for surgical dissection. The introduction of robotic technology has allowed for improved optics, surgical dexterity, and ergonomics with laparoscopic surgery but often requires more ports (3–6) and larger incisions (8–12 mm) to perform gynecologic procedures. In an effort to further reduce morbidity associated with the placement of multiple port sites and to improve the cosmetic outcomes of minimally invasive surgery, an even less invasive alternative to conventional laparoscopy or robotic surgery has been developed, known as laparoendoscopic single-site surgery (LESS). Preliminary advances in LESS have been documented in urologic and gastrointestinal surgery, and several reports demonstrate that the techniques are feasible provided that both optimal surgical technical expertise and optimal instrumentation are available [3], [4]. The purpose of this study was to describe the surgical outcomes and learning curve analysis associated with laparoendoscopic single-site RRSO with and without hysterectomy in BRCA carriers, women with breast cancer, and others at high risk for breast, ovarian, and/or endometrial cancer.
Section snippets
Methods
The study was approved by the institutional review board at the Cleveland Clinic (Cleveland, OH), Greater Baltimore Medical Center (Baltimore, MD), and Avera McKennan Hospital (Sioux Falls, SD). A retrospective, multi-institutional analysis of BRCA carriers and women at high risk for breast, ovarian, and endometrial cancer (HNPCC, Cowden's syndrome) who underwent LESS RRSO with or without hysterectomy from January to December 2009 was performed. All patients underwent surgery through a 1.5- to
Results
Fifty-eight LESS RRSOs were performed during the study time period at one of the three participating institutions. Thirteen (22%) of these patients also received a total laparoscopic hysterectomy using the LESS approach. All procedures were successfully completed through a LESS approach with no need for open conversion or for any extraumbilical skin incisions. No intraoperative complications were observed. Postoperative complications consisted of two vaginal cuff partial dehiscence (3.4%),
Discussion
Prophylactic salpingo-oophorectomy or RRSO is currently performed as part of a risk-reducing strategy for patients with an increased risk of ovarian or breast cancer due to an underlying genetic predisposition. RRSO is also performed as a therapeutic intervention for patients with hormone-positive premenopausal breast cancer. Increased knowledge and availability of genetic counseling and testing has helped to identify those women at a heightened risk for eventually developing ovarian, breast
Conflict of interest statement
There is no conflict of interest for any of the authors to report.
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