Laparoscopic Inguinal Gonadectomy in a Case of Familial Complete Androgen Insensitivity Syndrome and Inguinal Mass

Abstract

Study Objective Technical video demonstrating steps of inguinal gonadectomy in a case of complete androgen insensitivity syndrome (CAIS) with gonads in the inguinal canal. Design Technical video (Canadian Task Force classification III). Setting Gynecology department at a tertiary care hospital. Patients or Participants A patient with CAIS and inguinal mass. Interventions Laparoscopic inguinal gonadectomy and peritoneal closure at deep inguinal ring. Measurements and Main Results Androgen insensitivity syndrome (AIS) is a X-linked disorder of sex development with androgen receptor resistance. Phenotypic females with primary amenorrhea along with presence of testes and XY karyotype is diagnostic of AIS. Gonadectomy is usually advised in these patients as they are at risk of testicular germ cell tumor in undescended testis. The testes can be located at any position of embryological descent pathway. The patient in the present video is a 21 years old unmarried female with CAIS and testes present in inguinal canal. Her two siblings were also diagnosed with the same syndrome and one had undergone gonadectomy through inguinal incision. Laparoscopic inguinal gonadectomy is a minimally invasive approach with less intraoperative complications and pain, shorter hospital stay, faster postoperative recovery and aesthetically smaller scars. Laparoscopic inguinal gonadectomy is technically challenging as gonads are located in inguinal canal. We performed laparoscopic peritoneum dissection at the level of deep inguinal ring, identified the gonads and traction was applied aided with external push at level of external inguinal ring for successful retraction of gonads. Adequate closure of peritoneum at site of deep inguinal ring will prevent inguinal hernia in future. Conclusion Laparoscopic inguinal gonadectomy although technically difficult should be preferred over open inguinal incision to reduce postoperative morbidity. Technical video demonstrating steps of inguinal gonadectomy in a case of complete androgen insensitivity syndrome (CAIS) with gonads in the inguinal canal. Technical video (Canadian Task Force classification III). Gynecology department at a tertiary care hospital. A patient with CAIS and inguinal mass. Laparoscopic inguinal gonadectomy and peritoneal closure at deep inguinal ring. Androgen insensitivity syndrome (AIS) is a X-linked disorder of sex development with androgen receptor resistance. Phenotypic females with primary amenorrhea along with presence of testes and XY karyotype is diagnostic of AIS. Gonadectomy is usually advised in these patients as they are at risk of testicular germ cell tumor in undescended testis. The testes can be located at any position of embryological descent pathway. The patient in the present video is a 21 years old unmarried female with CAIS and testes present in inguinal canal. Her two siblings were also diagnosed with the same syndrome and one had undergone gonadectomy through inguinal incision. Laparoscopic inguinal gonadectomy is a minimally invasive approach with less intraoperative complications and pain, shorter hospital stay, faster postoperative recovery and aesthetically smaller scars. Laparoscopic inguinal gonadectomy is technically challenging as gonads are located in inguinal canal. We performed laparoscopic peritoneum dissection at the level of deep inguinal ring, identified the gonads and traction was applied aided with external push at level of external inguinal ring for successful retraction of gonads. Adequate closure of peritoneum at site of deep inguinal ring will prevent inguinal hernia in future. Laparoscopic inguinal gonadectomy although technically difficult should be preferred over open inguinal incision to reduce postoperative morbidity.