Transvaginal laparoscopic salpingo-oophorectomy: an oncological risk-reducing procedure

Aim: Since the first natural orifice transluminal endoscopic surgery procedure, renewed interest has arisen in further developing and advancing minimal access surgery. We introduce a natural orifice endoscopic approach for a bilateral salpingo-oophorectomy. Patients & methods: Using the vagina as a natural orifice, we performed a transvaginal laparoscopic salpingo-oophorectomy to remove bilateral adnexa in patients with a strong family history of ovarian and/or breast cancer and those positive for BRCA1/2 mutation. Results: Total 36 women underwent transvaginal laparoscopic salpingo-oophorectomy. Conversion to routine laparoscopy was required in eight patients to complete the operation. No peri-operative complications were noted. Conclusion: We describe a novel approach in gynecological surgery. Our technique proved to be safe and efficient with the advantage of avoiding any abdominal scars. Lay abstract: This article describes a novel, keyhole surgical approach to remove tubes and ovaries in a female patient. The approach is known as a 'natural orifice endoscopic approach' and involves using the vagina as a natural orifice. Both tubes and ovaries were removed in patients with a strong family history of ovarian and/or breast cancer and those positive for BRCA1/2 genetic mutation. Two ports are inserted into the vagina to access the abdomen with both specimens subsequently retrieved vaginally. Total 36 women underwent the procedure with no complications. The technique proved to be safe and efficient with the advantage of avoiding any abdominal scars compared with routine keyhole surgery.