Laparoscopic management of müllerian duct cysts in infants

Abstract

Purpose The aim of the study was to demonstrate the feasibility of laparoscopic excision of pelvic müllerian duct cysts (MDCs) in infants. Patients and Methods Three-month-old female and 13-month-old male infants presented with frequent episodes of urinary retention and were found to have large retrovesical cystic pelvic masses. Preoperative workup including abdominopelvic ultrasonography and computed tomographic scan showed bilateral hydroureteronephrosis in the baby girl and a single left anatomical kidney with hydroureteronephrosis in the baby boy, caused by the pressure effect of the mass. The pelvic mass in both infants was excised via transperitoneal laparoscopy via a retrovesical approach. Results The operative times were 140 minutes in case 1 and 160 minutes in case 2. Excellent laparoscopic visualization and magnification allowed meticulous dissection of the mass from the pelvic organs in both cases. In the female infant, a 5 × 5-cm collection located retrovesically was found 3 weeks after the operation. It contained serosanguinous fluid that was percutaneously aspirated under ultrasound guidance. Histopathologic examination showed the pelvic mass to be an MDC in both patients. Postoperative abdominopelvic sonography at 3 months showed no recurrence of the mass and resolution of hydroureteronephrosis. In the male infant, a urodynamic study 3 months after the operation showed normal bladder dynamics. No voiding difficulty was noted in regular follow-up visits at the time of this writing (7 months postoperatively). Conclusion Laparoscopic excision of pelvic MDCs in infants is technically feasible. It is a demanding and rarely reported procedure that offers excellent surgical exposure. Longer follow-up is necessary to see if this procedure will offer less morbidity than the open techniques.