Article Text

Standardized steps of risk-reducing salpingo-oophorectomy following the National Comprehensive Cancer Network guideline protocol: a video demonstration
  1. Jun Li,
  2. Menghan Zhu,
  3. Jie Duan and
  4. Wei Jiang
  1. Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
  1. Correspondence to Dr Wei Jiang, Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; jiangwei_fckyy{at}

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Risk-reducing salpingo-oophorectomy is now part of standard management for germline BRCA1/2 mutation carriers. It has been shown that risk-reducing salpingo-oophorectomy versus no risk-reducing salpingo-oophorectomy may have reduced the incidence of high grade serous cancer, and overall survival was longer with risk-reducing salpingo-oophorectomy compared with no risk-reducing salpingo-oophorectomy.1 The National Comprehensive Cancer Network (NCCN) guideline has proposed a detailed protocol for risk-reducing salpingo-oophorectomy (online supplemental table 1) without a video demonstration.2 3 Previously, Netter et al provided a stepwise demonstration of risk-reducing salpingo-oophorectomy in germline BRCA1 mutation carriers.4 However, the video failed to emphasize some key steps of risk-reducing salpingo-oophorectomy, including collection of pelvic washing for cytology, and removal of 2 cm of proximal infundibulo-pelvic ligament and all peritoneum surrounding the fallopian tubes and ovaries.4 This study aims to demonstrate the standardized steps of risk-reducing salpingo-oophorectomy following the NCCN guideline protocol by laparoscopy. The key steps of the procedure (online supplemental table 2 and table 3) are summarized as follows: (1) survey the upper abdomen, undersurfaces of the diaphragm, bowel surfaces, omentum, appendix, paracolic gutters, and the pelvis—biopsies should be taken from any abnormal findings; (2) collect pelvic washing for cytology; (3) resect the lateral peritoneum surrounding the fallopian tube and ovary; (4) perform ureterolysis (optional) (Figure 1); (5) remove 2 cm of proximal infundibulo-pelvic ligament; (6) resect the dorsal peritoneum surrounding the tube and ovary; (7) cut the fallopian tube at the level of the cornua; (8) divide the utero-ovarian ligament; (9) remove the resected adnexa with the surrounding peritoneum in a disposable pocket. The fallopian tubes and ovaries were processed following the Sectioning and Extensively Examining the Fimbriated End (SEE-FIM) protocol to make an accurate pathologic diagnosis. In conclusion, this video demonstrates the performance of each part of the risk-reducing salpingo-oophorectomy in a logical sequence, making the procedure easier to realize.

Supplemental material

Figure 1

Exposure of the ureter to avoid incidental injury to it during risk-reducing salpingo-oophorectomy.

Video 1 Standardized steps of risk-reducing salpingo-oophorectomy following the National Comprehensive Cancer Network guideline protocol.

Data availability statement

All data relevant to the study are included in the article.

Ethics statements

Patient consent for publication

Ethics approval

This study involves human participants and was approved by the Institutional Review Board of the Obstetrics and Gynecology Hospital of Fudan University (approved number: No.2022-13, approved date: 01-24-2022). Participants gave informed consent to participate in the study before taking part.


Supplementary materials

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  • Contributors Contribution of authorship is as follows: Conception and design: JL, WJ. Collection and assembly of data: JL, WJ. Data analysis and interpretation: all authors. Manuscript writing: JL, WJ. Final approval of manuscript: all authors. Author responsible for the overall content as the guarantor: WJ.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.