title: Single-port risk-reducing salpingo-oophorectomy with and without hysterectomy: surgical outcomes and learning curve analysis.
abstract: OBJECTIVE
  Based on considerable prospective data, risk-reducing salpingo-oophorectomy (RRSO) is one of the most beneficial interventions available to reduce ovarian/breast cancer risk in BRCA carriers and high-risk women. The purpose of this study was to describe the initial surgical outcomes and learning curve analysis associated with laparoendoscopic single-site (LESS) RRSO with and without hysterectomy.
  
  
  METHODS
  A retrospective, multi-institutional analysis of BRCA carriers and women at high risk for breast/ovarian cancer who underwent LESS RRSO with and without hysterectomy in 2009 was performed. Data collected included age, BMI, procedure, operative time, length of hospital stay, postoperative pain scores, and post operative complications. Student t-test, Pearson correlation coefficient, and multivariate linear regression were used for analysis.
  
  
  RESULTS
  A total of 58 patients were evaluated; 36 (63%) were BRCA1/2 carriers and 38 (63%) had breast cancer. Patients' mean age and BMI were 46 years and 27 kg/m(2), respectively. Most patients were Caucasian (76%), and at the time of prophylactic surgery, 53% of patients were undergoing active breast cancer treatment. Mean operative time was 38.1 minutes (16-80 minutes). All cases were performed successfully via the LESS approach, and there were no surgical complications. Multivariate linear regression analysis was done, and after controlling for study site, previous abdominal surgery, active cancer treatment, and BMI, operative time was only influence by number of cases performed, p=0.019.
  
  
  CONCLUSIONS
  LESS RRSO is feasible and safe with favorable surgical and cosmetic outcomes. In our experience, surgical proficiency is possible after 10-15 cases. The LESS approach may be ideal for BRCA mutation carriers and breast cancer patients because of a short convalescence, permitting minimal interruption in any ongoing cancer treatment and the potential psychological benefits from improved cosmesis and pain control. Prospective studies are needed to assess the relative benefits of LESS compared with more conventional minimally invasive approaches.
authors.affiliation: Department of OB/GYN and Women's Health Institute, Section of Gynecologic Oncology, Cleveland Clinic, Cleveland, OH 44195, USA. escobap@ccf.org
authors.forename: Pedro F
authors.initials: PF
authors.lastname: Escobar
authors.forename: David C
authors.initials: DC
authors.lastname: Starks
authors.forename: Amanda Nickles
authors.initials: AN
authors.lastname: Fader
authors.forename: Matthew
authors.initials: M
authors.lastname: Barber
authors.forename: Luis
authors.initials: L
authors.lastname: Rojas-Espalliat
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000235:genetics / Q000517:prevention & control* / Q000601:surgery; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D018095:Germ-Line Mutation; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000235:genetics / Q000517:prevention & control* / Q000601:surgery; D010052:Ovariectomy / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome