Simultaneous vaginal natural orifice transluminal endoscopic surgery (vNOTES) risk-reducing bilateral salpingo-oophorectomy and mastectomy in a patient with BRCA1 gene mutation and multifocal triple-negative breast cancer

Abstract

A patient with triple-negative multifocal invasive carcinoma of the left breast was subsequently diagnosed as having BReast CAncer (BRCA) 1 gene. Following neoadjuvant chemotherapy and immunotherapy, she underwent left-sided therapeutic and right-sided risk-reducing mastectomy with concomitant vaginal natural orifice transluminal endoscopic surgery (vNOTES), bilateral salpingo-oophorectomy (BSO) in view of her BRCA status. The vNOTES approach provides a novel alternative to conventional laparoscopy by combining vaginal entry with excellent fibreoptic views and use of endoscopic instruments. This has the advantage of avoiding abdominal trocar incisions, improved cosmesis, reduced pain and quicker recovery. Coordinated vNOTES risk-reducing BSO performed at the same surgical session as mastectomy has not been previously described in the literature and obviates the need for repeat anaesthesia and additional bed occupancy. Our case report supports the adoption of vNOTES as a patient-friendly alternative to laparoscopy, which can be performed concurrently at the time of mastectomy.

Keywords: Breast cancer; Gynecological cancer; Obstetrics and gynaecology; Oncology.