Laparoscopic Transposition of the Ovaries: Is It Effective to Preserve Ovarian Function Before Pelvic Node Irradiation in Pediatric Patients?

Abstract

The potential disadvantages of elective pelvic node irradiation in young girls with Hodgkin's disease include ovarian failure and possible future infertility. Prophylactic laparoscopic transposition of the ovaries from the radiation field, or oophoropexy, can spare ovarian function in many girls. The authors report the case of a laparoscopic bilateral oophoropexy performed in a 9-year old girl suffering from mixed-cellularity Hodgkin's disease. Laparoscopy was performed using four trocars: one for a 10-mm 0° telescope placed infraumbilically, a 10-mm trocar above the symphysis pubis, and two 5-mm trocars at the lower left and right quadrants. The ovaries were transposed by placing two nonresorbable sutures through the utero-ovarian ligaments and posterior part of the uterus. Two titanium clips were placed to help locate the ovaries postoperatively. Surgery lasted 45 min. There were no intra- or postoperative complications. The patient was discharged from the hospital after 24 h. One year after the first intervention, at the end of radiotherapy, a second laparoscopic exploration was performed to evaluate and reposition the ovaries under visual guide. After a 3-year follow-up, hematologic evaluation of the patient's hormone levels and an ultrasonographic exam showed severe impairment of the ovarian function. The authors believe that laparoscopic oophoropexy is a feasible and easy procedure to use on children, although on the basis of these data, it may not always be sufficient to prevent ovarian failure secondary to radiotherapy.