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Standardized steps of risk-reducing salpingo-oophorectomy following the National Comprehensive Cancer Network guideline protocol: a video demonstration
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  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}163.com

https://doi.org/10.1136/ijgc-2023-004794

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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
    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.

    References

    1. ↵
      1. Eleje GU,
      2. Eke AC,
      3. Ezebialu IU, et al
      . Risk-reducing bilateral salpingo-oophorectomy in women with BRCA1 or BRCA2 mutations. Cochrane Database Syst Rev 2018;8:CD012464. doi:10.1002/14651858.CD012464.pub2
    2. ↵
      Ovarian cancer including fallopian tube cancer and primary peritoneal cancer version 2. NCCN Clinical Practice Guidelines in Oncology; 2023. Available: https://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf)
    3. ↵
      1. Powell CB,
      2. Chen L,
      3. McLennan J, et al
      . Risk-reducing salpingo-oophorectomy (RRSO) in BRCA mutation carriers: experience with a consecutive series of 111 patients using a standardized surgical-pathological protocol. Int J Gynecol Cancer 2011;21:846–51. doi:10.1097/IGC.0b013e31821bc7e3
      OpenUrlAbstract/FREE Full Text
    4. ↵
      1. Netter A,
      2. Niddam R,
      3. Agostini A, et al
      . Vaginal notes approach for risk-reducing salpingo-oophorectomy in BRCA mutation carriers: a video demonstration. J Gynecol Obstet Hum Reprod 2021;50. doi:10.1016/j.jogoh.2021.102212

    Supplementary materials

    • Supplementary Data

      This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Footnotes

    • 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.