Risk reduction bilateral salpingo-oophorectomy with vNOTES: A new era in cancer prevention strategies.

Women with BRCA1 and BRCA2 mutations face a significantly increased lifetime risk of developing ovarian and fallopian tube cancer. Minimally invasive techniques are the gold standard access to perform risk-reduction operations. This study aims to evaluate the feasibility and safety of prophylactic bilateral salpingo-oophorectomy using the vaginal natural orifice transluminal endoscopic surgery (vNOTES) technique as a risk-reduction strategy. A prospective study was conducted between October 2023 and December 2024, involving 25 high-risk women at an international, university-affiliated cancer center. All patients underwent prophylactic bilateral salpingo-oophorectomy via transvaginal access using vNOTES. Key data collected included age, BMI, operative time, and blood loss, with primary outcomes focusing on feasibility, complications, and recovery. Twenty-five BRCA-mutated patients underwent prophylactic bilateral adnexectomy via vNOTES. Median age was 48 years (range 41-59) and median BMI 24.1 kg/m2 (range 19.1-30.4). All procedures were completed without conversion to laparoscopy or laparotomy, and vNOTES enabled full abdominal exploration. Median operative time was 40 min (IQR 32-44), with minimal blood loss (<100 mL in 96 %) and no intraoperative complications. Postoperative recovery was uneventful, with no pain reported and 96 % of patients discharged the same day. No late complications related to the surgical technique were observed. Prophylactic bilateral salpingo-oophorectomy using the vNOTES technique appears to be a feasible and safe option for reducing the risk of ovarian and fallopian tube cancers in high-risk women. Further studies with larger cohorts are needed to validate these findings.