8732 Laparoscopic Bilateral Gonadectomy in a Patient with Mosaic 45,X/46,XY Turner Syndrome

Abstract

<h3>Study Objective</h3> To demonstrate a laparoscopic technique for prophylactic bilateral gonadectomy in a patient with mosaic 45,X/46,XY Turner syndrome. <h3>Design</h3> We present a stepwise, narrated demonstration of our technique for risk reducing bilateral gonadectomy. We highlight key anatomy, and place special attention on techniques to permit excision of at least 2 cm of the gonadal vessels with the specimen. <h3>Setting</h3> Referral center in Upstate New York. <h3>Patients or Participants</h3> 27-yo G1P1 diagnosed with mosaic Turner syndrome (45,X/46,XY) <h3>Interventions</h3> Visual inspection of the pelvis was performed, and pelvic washings were obtained. The course of the ureter was dissected out within the retroperitoneal space, developing a window between the ureter and gonadal vessels. The peritoneum was opened medial and lateral to the streak gonad to ensure removal of all tissue with potential for malignancy. The infundibulopelvic ligament (IP) was skeletonized and gonadectomy was performed transecting the IP 3-4 cm cephalad to the streak gonad. The same procedure was completed on the opposite side. <h3>Measurements and Main Results</h3> Successful laparoscopic bilateral gonadectomy was performed with an estimated blood loss of 5mL. Pathology demonstrated bilateral streak gonads without evidence of germ cell tumor. <h3>Conclusion</h3> Given the inability to reliably diagnose the presence of germ cell tumors in streak gonads preoperatively, the use of wide dissection at the time of laparoscopic bilateral gonadectomy for risk reduction in mosaic Turner Syndrome patients with Y-chromosome material is an important consideration.