Robotic Laparoscopic Prophylactic Removal of Tubes and Ovaries
Hereditary breast and ovarian cancer (HBOC) syndrome is an inherited cancer-susceptibility syndrome. Options for patients, who test positive for BRCA1 or BRCA2 mutation, include surveillance, chemoprevention, and surgery. Available ovarian cancer screening tests/procedures are very limited and there is no evidence that screening alone has reduced the mortality or improved survival associated with hereditary breast and ovarian cancer syndrome. Hopefully we will develop better serum markers and improved screening algorithms in the future to aid our existing tests. For the time being, consensus groups have recommended periodic screening with CA 125 and transvaginal ultrasonography, beginning between 30-35 years old or 5-10 years earlier than the earliest age of first diagnosis of ovarian cancer in the family (but not earlier than 21 years old). Given the limitations of current ovarian cancer screening approaches, preventive/prophylactic removal of ovaries and fallopian tubes (bilateral salpingo-oophrectomy BSO) should be offered to patients with HBOC syndrome by the age of 40 years old or after childbearing is completed. This can decrease the threat of ovarian, fallopian tube and primary peritoneal cancers by approximately 85-90% and also has been shown to reduce overall mortality in HBOC syndrome patients.
Traditional surgery to prophylactically remove the ovaries and tubes involves a large incision in the abdomen. This results in significant pain as well as inpatient stay of 2-3 days and additional recovery of 4-6 weeks. The best approach is to perform minimally invasive surgery via a laparoscopic bilateral salpingo-oophrectomy (BSO). The advantages of a laparoscopic approach include better visualization, decreased pain, much shorter recovery time and better cosmetic outcome. The procedure is performed in an outpatient surgery center under general anesthesia and patients go home the same day.
Learn more about Hereditary Breast and Ovarian Cancer (HBOC) Syndrome and BRCA1 or BRCA2 mutation testing.