Page 10 - WALS Journal

Mohammed Khairy Ali et al

serous carcinomas. Patients with a BRCA1 or BRCA2 gynecologic oncologies. Wheeless and Wheeless and
mutation also have an increased risk of developing other Thompson reported in the 1960s that more than 4,000
rare gynecological cancer, like fallopian tube carcinoma. women underwent rapid, inexpensive, effective surgical
This indication leads to development of a risk reduction sterilization by using single-trocar laparoscopy. In 1991,
strategy that includes removal of the ovaries and tubes to Pelosi and Pelosi performed the first hysterectomy using a
prevent the development of carcinoma. single-trocar technique. 29
Many studies proved that prophylactic bilateral salpingo- The ovarian cancer is responsible for more deaths than
oophorectomy reduces ovarian cancer risk in BRCA1 and all other gynecologic malignancies combined. Each year in
BRCA2 mutation carriers by about 96%. Additionally, if the United States, 204,000 women are diagnosed, and
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the prophylactic bilateral salpingo-oophorectomy is done 125,000 women die from this disease. The epithelial
perimenopausally, the risk of development of cancer breast ovarian carcinomas comprise 90 to 95% of all cases,
decrease up to 50 to 68%. 27 including the more indolent low malignant potential
Another inherited mutation include mutation which (borderline) tumors. 3
occur in certain genes like MSH2, MLH1, PMS2 and MSH6 The treatment of ovarian cancer is dependable on many
which called DNA MMR genes, this mutation leads to factors; however, the most important factors are age of the
Lynch syndrome or HNCC, in this syndrome the most patient, the parity, and the stage of disease when discovered.
common cancers which occur are colon, endometrial and In stage I ovarian cancer, the LESS is used mainly in staging
ovarian cancer. 28 which consider being a primary treatment. In those with
However, the decision to perform prophylactic risk- advanced disease, laparoscopy is used in visualization of
reducing oophorectomy should be based on several patient abdominal organ and it gives a picture about the respect-
factors and choices not only on the age, women undergoing ability of the tumor, so all the required procedures could be
prophylactic bilateral salpingo-oophorectomy should be proceeded safely by laparoscopy. 31
counseled about the risks and benefits of hormone The treatment of the early stage ovarian cancer is simple
replacement therapy before surgery. So for women with hysterectomy and bilateral salpingo-oophorectomy, then
BRCA1 mutations, risk-reducing prophylactic bilateral bilateral pelvic lymph node dissection should be done
salpingo-oophorectomy should be done after the complete through an incision in the retroperitoneal space. All these
the child-bearing period, but for individuals with a personal procedures were successfully performed via LESS by a
or family history of breast and ovarian cancer who have not single 2 to 3 cm incision and there were no conversions to
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had genetic testing or who have undergone these testing multiport laparoscopy or open surgery.
and no mutations in BRCA1 or BRCA2 gene is detected, The epithelial ovarian cancers develop in about 10% in
the risks and benefits of prophylactic bilateral salpingo- women younger than 40 years of age, so the fertility sparing
oophorectomy is not proved yet. So these individuals are surgery, which include unilateral adnexectomy, may be an
option in selected patients when disease is present only in
best managed by strict follow-up by gynecologists, one ovary, this can be easily done by LESS. Instrument
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oncologists, and geneticists to detect any risk for cancer. crowding was noted in most cases done by LESS but if we
So risk-reducing oophorectomy should be done to select
women when: use a laparoscope with a flexible tip (the 30° Viscera Endo
Eye) or articulating instruments, this will be easy.
1. The women have a positive BRCA1 or BRCA 2 genetic LESS gives better cosmesis due to hidden umbilical scar
test. so it is psychologically more supportive due to good body
2. There is a first-degree family history of ovarian cancer. image, and the risk of visceral and vascular injury during
3. There are two or more second-degree relatives with trocar placement is low, which decrease the morbidity rate
history of ovarian cancer or breast cancer. and also there is decreased risk of postoperative wound
4. When women will use estrogen as adjuvant therapy in infection, hernia formation, and also fewer incisions may
treatment of breast cancer. result in faster recovery and so the administration of adjuvant
5. Bilateral salpingo-oophorectomy should be done with therapies will be faster. Also, the use of LESS plays an
hysterectomy in HNPCC syndrome.
important role in reduction of postoperative pain and
narcotics use.
LESS SURGERY FOR OVARIAN CANCER
Laparoscopic surgery has become the preferred surgical LESS SURGERY FOR ENDOMETRIAL CANCER
approach for a variety of gynecologic oncology; single-port In the last years, many studies proved that laparoscopic
laparoscopy is not a new method in mangement of various approaches to various gynecologic oncology conditions
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