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Risk-reducing surgery is primarily performed for patients with BRCA-positive hereditary breast–ovarian cancer syndrome and, in some countries, for patients with other genetic mutations.1 Currently, most risk-reducing salpingo-oophorectomy procedures are performed laparoscopically. However, using the novel technique of vaginal natural orifice transluminal endoscopic surgery (vNOTES) can be beneficial due to its minimally invasive nature. Risk-reducing salpingo-oophorectomy with vNOTES results in no scar and less pain compared with traditional procedures.2 The video describes the pros and cons of risk-reducing salpingo-oophorectomy with vNOTES as outlined below.
Step 1. The Douglas pouch is incised via a transvaginal approach, after which the transvaginal instrument is attached.
Step 2. Intra-abdominal observation is performed, and ascites are collected through the transvaginal approach. If the observation area is insufficient, it is recommended to add the supportive trocar to the umbilicus. The ovarian vessels and fallopian tube are isolated and ligated after exposing the retroperitoneal space. The key point is to maintain a distance 2–3 cm from the ovary (Figure 1).
Step 3. The vaginal incision site is sutured.
Ligation point of ovarian vessels.
This method has two limitations: the observation area of intra-abdominal wall and the indication of surgery. Therefore, it is important to recognize that adding an assisted trocar may be necessary for adequate observation, and this method is not suitable for cases with adhesions due to the limitations of forceps manipulation. Despite these limitations, risk-reducing salpingo-oophorectomy with vNOTES may be the best choice for patients with hereditary breast and ovarian cancer, as this novel method is less invasive and offers a more effective technique for risk-reducing salpingo-oophorectomy.
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 but our study was not considered research by the National Health Service, which exempted it from requiring ethics approval.
Acknowledgments
The authors wish to express their appreciation to the Gynecologic Team at Sapporo Medical University and Tomonori Hada at Yotsuya Medical CUBE for their advice.
Footnotes
Contributors All the authors (MT, MM, SN, SK, TA, TS) contributed to the creation of the video and wrote the associated article. MT is responsible for the overall content as guarantor.
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.