Needleoscopic-assisted risk-reducing bilateral salpingo-oophorectomy in BRCA1/2 mutation carriers: Peri-operative outcomes and psychological impact

Objective: To investigate the role of needleoscopic-assisted laparoscopy in terms of surgical impact and psy-chological outcomes in RR-BSO for BRCA1/2 patients.& nbsp;Study design: Prospective monocentric trial conducted at the Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCSS in Rome. Between March 2016 and March 2018, 26 consecutive patients were prospectively enrolled in the study and underwent RR-BSO. Peri-operative surgical variables were collected. The psychological interview was performed at the discharge and during the first post-operative follow-up visit (between 30 and 60 days after surgery).& nbsp;Results: We reported a median OT of 18.5 min (range, 15-37), a median EBL of 0 mL (0-20), and no conversion to laparoscopy or laparotomy. The median VAS score was at rest of 2, 3, and 1; while under Valsalva maneuver was 4, 3, 2, respectively at 2, 4, and 24 h. 77% (20/26) of the whole population had a previous diagnosis of breast cancer. All patients expressed great cosmetic satisfaction both at discharge and after 30/60 days, with an 84.6% of score 5 and a 15.4% of score 4. The highest number of score 5 , concerning the cosmetic outcomes, were clustered in the subgroup of breast cancer survivors with a 95% of score 5 versus 50% of score 5 in patients with no previous breast cancer (p = 0.0073). Similarly, the maximal psychological advantage of the ultra-MIS approach was revealed in the breast cancer survivors (70% of score 5 versus 16% of score 5, p = 0.02).& nbsp;Conclusions: The use of 2.4 mm instruments raises the possibility of decreasing post-operative incisional pain, reducing hospitalization, and ensuring better cosmetic and psychological outcomes without increasing complications. The full psychosomatic benefit of ultra-MIS within BRCA mutation carriers is revealed in breast cancer survivors, probably due to the comparison with the mutilating and invasive previous breast surgery.

Automated summary

This study investigates the surgical impact and psychological outcomes of needleoscopic-assisted laparoscopy in RR-BSO for BRCA1/2 patients. The results show that the use of 2.4 mm instruments in ultra-minimally invasive surgery can reduce post-operative incisional pain, shorten hospitalization, and improve cosmetic and psychological outcomes, especially in breast cancer survivors.