Introduction

Advancements in minimally invasive surgery have transformed the management of both benign abdominal conditions and hereditary cancer prevention strategies. Combining surgical procedures in a single operative session offers multiple benefits, including reduced anesthesia exposure, shorter hospital stay, faster recovery, and improved patient convenience. One such evolving approach is the combination of laparoscopic cholecystectomy with risk-reducing bilateral salpingectomy in patients carrying a BRCA1 gene mutation.

BRCA1 mutation carriers face a significantly increased lifetime risk of breast and ovarian cancer. Recent evidence suggests that many high-grade serous ovarian cancers originate from the distal fallopian tubes, making prophylactic salpingectomy an important preventive strategy. Simultaneously, gallbladder disease such as symptomatic cholelithiasis remains a common surgical condition requiring cholecystectomy. Performing both procedures together through minimally invasive techniques can be safe, feasible, and beneficial in selected patients.

Background of BRCA1 Mutation and Cancer Risk

The BRCA1 gene functions as a tumor suppressor responsible for DNA repair. Mutations in this gene compromise genomic stability and markedly elevate the risk of breast and ovarian malignancies. Women with BRCA1 mutations may have up to a 40–60% lifetime risk of ovarian cancer.

Traditionally, prophylactic bilateral salpingo-oophorectomy has been considered the gold standard for ovarian cancer risk reduction. However, in younger women who wish to preserve hormonal function and avoid premature menopause, risk-reducing salpingectomy with delayed oophorectomy is increasingly being explored. Bilateral salpingectomy removes the fallopian tubes while preserving ovarian endocrine function.

Case Scenario

A 42-year-old female with symptomatic gallstones presented with recurrent episodes of right upper abdominal pain, nausea, and dyspepsia. Ultrasonography confirmed multiple gallstones with chronic cholecystitis. The patient also had a strong family history of breast and ovarian cancer, and genetic testing revealed a pathogenic BRCA1 mutation.

Following multidisciplinary consultation involving a gynecologic oncologist, general surgeon, and genetic counselor, the patient opted for combined minimally invasive surgery consisting of laparoscopic cholecystectomy and bilateral risk-reducing salpingectomy.

Surgical Technique

Patient Positioning and Port Placement

Under general anesthesia, the patient was placed in a supine position. Pneumoperitoneum was established using a Veress needle technique. Standard laparoscopic ports for cholecystectomy were inserted, with additional pelvic visualization achieved through minor adjustment of port angles.

Laparoscopic Cholecystectomy

The gallbladder was retracted cephalad to expose Calot’s triangle. Careful dissection identified the cystic duct and cystic artery. After obtaining the critical view of safety, both structures were clipped and divided. The gallbladder was dissected from the liver bed using electrocautery and extracted through the umbilical port.

Risk-Reducing Bilateral Salpingectomy

Attention was then directed toward the pelvis. Both fallopian tubes appeared grossly normal. Using advanced bipolar energy devices, the mesosalpinx was carefully coagulated and divided while preserving ovarian blood supply. Both fallopian tubes were removed completely from the fimbrial end to the uterine cornua. Specimens were sent separately for histopathological examination using the SEE-FIM protocol to detect occult serous tubal intraepithelial carcinoma.

Advantages of Combined Minimally Invasive Surgery

Reduced Anesthesia Exposure

Combining procedures eliminates the need for separate surgeries and repeated exposure to general anesthesia, particularly beneficial for patients with comorbidities or cancer-related anxiety.

Faster Recovery

Patients recover from both procedures simultaneously, resulting in shorter overall downtime and quicker return to daily activities.

Cost-Effectiveness

Single hospitalization, combined operating room utilization, and reduced postoperative care contribute to lower overall healthcare costs.

Enhanced Patient Satisfaction

Patients often prefer a single surgical intervention rather than multiple staged procedures, reducing emotional stress and improving treatment compliance.

Postoperative Outcome

The patient recovered uneventfully and was discharged within 24 hours. Oral intake was resumed on the same day, and postoperative pain was minimal. Histopathology confirmed chronic calculous cholecystitis with no evidence of malignancy in the gallbladder or fallopian tubes.

At follow-up, the patient reported significant improvement in symptoms and expressed satisfaction with the preventive cancer strategy undertaken during the same surgery.

Discussion

The concept of opportunistic or prophylactic salpingectomy has gained widespread acceptance due to increasing evidence supporting the tubal origin theory of high-grade serous ovarian carcinoma. In BRCA1 mutation carriers, prophylactic surgery plays a critical role in cancer prevention.

Simultaneous minimally invasive procedures require careful patient selection, multidisciplinary planning, and surgical expertise. The operative duration may be slightly longer; however, the overall benefits often outweigh the risks. Maintaining sterility, preventing injury to adjacent structures, and ensuring adequate oncologic specimen handling are essential considerations.

Several studies have demonstrated the safety and feasibility of combined laparoscopic surgeries without increasing perioperative complications. The use of advanced energy devices, high-definition imaging, and refined laparoscopic skills further enhances surgical outcomes.

Conclusion

Combined minimally invasive cholecystectomy and risk-reducing bilateral salpingectomy represents a safe and effective surgical approach in selected BRCA1 mutation carriers with coexisting gallbladder disease. This strategy minimizes surgical burden, improves patient convenience, and supports proactive cancer prevention without compromising recovery.

As preventive gynecologic oncology continues to evolve, multidisciplinary minimally invasive approaches will play an increasingly important role in personalized patient care. Early genetic counseling, proper surgical planning, and individualized decision-making remain essential for optimizing outcomes in BRCA1 mutation patients.