Abstract
Video Objective This video is intended for any gynecologic surgeon who is performing risk-reducing surgery in their practice. We intend to review the “best practices” recommended by ACOG when performing a risk-reducing bilateral salpingo-oophorectomy (RR-BSO) in patients with Hereditary Breast and Ovarian Cancer Syndrome. Setting Academic Medical Center Interventions This video describes the case of a 36-year-old female diagnosed with a BRCA 1 mutation who has completed childbearing and desires RR-BSO. There are four elements that are critical to include in risk-reducing procedures: 1. A thorough visualization of all peritoneal surfaces and accessible intraperitoneal organs should be performed. 2. Washings should be obtained. 3. The ovary should be removed in its entirety, and the fallopian tubes should be removed at their uterine insertion point at the cornua. 4. Complete serial sectioning of the ovaries and fallopian tubes performed by pathology is necessary, with microscopic examination for occult cancer. Conclusion These “best practices” should be employed by all surgeons when performing a RR-BSO in order to most effectively increase detection of early neoplastic changes and occult malignancy, and to decrease their patient's risk of developing ovarian and fallopian tube cancer.
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