A Different Approach in High Risk Patients for Ovarian Cancer: Single-port Vs Conventional Multi-port Access in Prophylactic Laparoscopic Bilateral Salpingo- oophorectomy (BSO).Comparison of Surgical Outcomes.

Background To evaluate the surgical outcomes associate risk-reducing salpingo-oophorectomy performing in single port comparing multi-port laparoscopy in women with high risk for ovarian cancer. SPAL- BSO is feasible and safe with favorable surgical and cosmetic outcomes compared to conventional laparoscopy. Methods Prospective, multicentric, case-control study of patients with a high risk of ovarian cancer undergoing a BSO. Ninety-nine out of 115 patients met the inclusion criteria and entered the study. Patients were informed about the two types of surgeries and were alternatively assigned to undergo an SPAL-BSO with optimal laparoscopic experience and at least 1 year of training for this procedure or an MPL-BSO performed by skilled laparoscopic surgeons without SPAL experience. Collected data were patient characteristics (age, BMI [kg/m2]), co-morbidity, type and duration of surgery, estimated blood loss (EBL), postoperative pain score, perioperative complications, length of hospital stay, use of analgesics, and cosmetic satisfaction. At the end of each procedure, intra-operative data—trocar introducing time, operative time, EBL, intra- and peri-operative complications, and conversion to standard-multi-access laparoscopy or laparotomy—were registered. Results In total we performed 99 surgical procedures: 49 SPAL-BSO (group A) and 50 MPL-BSO (group B). There were no differences in the demographic and preoperative data between the two groups. SPAL-BSO mean operative time was statistically significantly lower than MPL. The time of entry into the abdominal cavity was significantly lower in group A as was the extraction time of the specimens. Pain measured immediately after surgery in the recovery unit was lower in the SPAL-BSO group than in the MPL-BSO group. Moreover, postoperative pain scores after 6, 12, and 24 h were lower in the SPAL-BSO group compared with the MPL-BSO group. Cosmeti satisfaction was significantly higher in SPAL group (p<0.001). Conclusions SPAL-BSO is feasible and safe with favorable surgical and cosmetic outcomes compared to conventional multiport laparoscopy