Abstract
Laparoscopic procedures are constantly finding wider application in general and pediatric surgery. The female child and adolescent presenting with suspected acute or chronic ovarian pathology may be an ideal candidate for laparoscopic surgery. From March 1992 to December 1993, six girls aged 7 to 18 years underwent seven laparoscopic operations for ovarian pathology at Childrens Hospital Los Angeles. Clinical presentations included virilization with primary amenorrhea (1), precocious puberty (1), malignant dysgerminoma (second look) (1), and abdominal pain (3). Postoperative diagnoses were dysgerminoma (1), bilateral gonadoblastoma in a 46 XY chromosomal phenotypic femal with dysgenetic gonads (1), negative bipsy (1), serous cystadenoma with acute torsion (1), ovarian cysts (1), and ovarian torsion (1). Operations performed were unilateral salpingo-oophorectomy (1), unilateral salpingo-oophorectomy with contralateral biopsy (2), bilateral salpingo-oophorectomy (1), diagnostic biopsy (2), and ovarian cystectomy with oophoropexy (1). There were no operative complications. One patient underwent two operations, a biopsy followed by unilateral salpingo-oophorectomy. Only one patient required a mini-laparotomy for delivering a large tumor mass. Mean operative time was 138 min, mean hospital stay 2.0 days. We encountered two malignant cases, which were definitively treated by laparoscopic resection. These two patients remained free of disease 12 to 18 months later. The laparoscopic approach to ovarian pathology in children and adoloscents in an effective method for diagnosis as well as definitive therapy. Our initial experience is presented followed by recommendations for clinical practice.
Highlights
Laparoscopy for adult gynecologic pathology was commonplace long before the recent revolution in laparoscopic surgery
One patient required a mini-laparotomy for delivering a large tumor mass
The dawn of modern laparoscopic surgery was heralded by the wide acceptance of laparoscopic cholecystectomy by surgeons and patients alike
Summary
Laparoscopy for adult gynecologic pathology was commonplace long before the recent revolution in laparoscopic surgery. In 1973, Gans and Berci reported their experience with five pediatric patients who were successfully explored and biopsied laparoscopically for intersex problems, gonadal dysplasia, and precocious puberty [4]. Cognat et al reported 60 laparoscopic cases in children as young as 6 months for a variety of gynecological problems [2]. In 1991, Shalev succeeded in performing laparoscopic detorsion of an adnexa in a child [15] and in 1992, Heloury et al.'s series of laparoscopies for pediatric adnexal pathology was reported from France [6]. Tan et al presented two children who successfully underwent laparoscopic oophoropexy for pelvic malignancies [17]. The pediatric surgical experience with laparoscopy for suspected or diagnosed ovarian pathology continues to develop
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