Validation of adopting vaginal natural orifice transluminal endoscopic surgery for risk-reducing salpingo-oophorectomy for women with germline BRCA1/2 pathogenic variants analysis from conventional procedure.

Objective: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is less invasive than conventional transabdominal laparoscopic surgery for benign gynecological indications. When adopting this procedure for risk-reducing salpingo-oophorectomy (RRSO) in women with hereditary breast and ovarian cancer (HBOC), the ventral side of the uterus becomes a blind area, which is a challenge. To clarify the effects of this blind area on the treatment outcome of HBOC, we examined the clinical data of RRSO using conventional procedures for women with germline BRCA1/2 pathogenic variants who were treated at our institution.

Methods: A retrospective chart review was performed. The clinical data of patients who underwent RRSO using the conventional procedure between 2011 and July 2024 were extracted. All included patients were preoperatively examined using vaginal ultrasonography, contrast-enhanced pelvic magnetic resonance imaging, and carcinoma antigen-125 level measurements to exclude ovarian cancer development.

Results: A total of 267 patients underwent RRSO at our institution. The mean age at RRSO was 50.1 years. Five cases of occult invasive cancer (1.9%) and 10 cases of serous tubal intraepithelial carcinoma (3.7%) were identified postoperatively. One patient (0.37%) showed macroscopic peritoneal dissemination in the omentum. None of the 252 patients without occult cancer developed peritoneal cancer during the mean observational time of 62.4 months No patient presented with peritoneal lesions ventral to the uterus.

Conclusion: Macroscopic tumors on the peritoneum ventral to the uterus were rare when strict preoperative screening for ovarian cancer was performed. vNOTES can be safely adopted for RRSO in patients with HBOC, without evident disadvantages.