Giant, highly vascular sacrococcygeal teratoma: Report of its excision using the ligasure vessel sealing system

Abstract

Reports about giant, highly vascular sacrococcygeal teratoma (GHV-SCT) are uncommon. A boy with a prenatally diagnosed GHV-SCT was born at 34 weeks’ gestation weighing 3,716 g. At birth, the GHV-SCT was 20 × 17 × 14 cm. After initial devascularization using an aortic snare, excision of the GHV-SCT was started using monopolar diathermy, but hemorrhage from cutaneous collateral vessels was difficult to control, and individual ligation of vessels was extremely time consuming. The authors then used the LigaSure (LS) vessel sealing system (Valleylab, Boulder, CO) to control intraoperative hemorrhage. Hemostasis was achieved easily with LS, without any need for vessel ligation; the operative field was dry and the efficiency of excision enhanced. Total operating time was 255 minutes, but excision of the GHV-SCT itself took only 16 minutes. The GHV-SCT weighed 1,208 g or 325.1 g/kg body weight. Total blood loss was 77 mL or 20.7 mL/kg body weight, which was minimal compared with other cases in the literature. At the last follow-up examination, 7 months after surgery, he remains well with no evidence of recurrence. LS was extremely useful for controlling intraoperative hemorrhage in this case, and we strongly recommend its selective use for excising highly vascular SCT.