P141 OVARIAN SPARING LAPAROSCOPIC TERATOMA EXCISION

Background: Solid ovarian tumors are uncommon in childhood. Diagnosis is based on clinical features (age and hormonal status), imaging and tumor markers. Complete tumor resection is mandatory, but for benign lesions, healthy ovarian tissue must be preserved, while tumor spillage must be avoided. The role of laparoscopy to manage pediatric solid ovarian tumors is controversial.

Aim: This video describes a technique that combines the advantages of laparoscopy to remove a benign, solid pediatric ovarian tumor, while preserving healthy ovarian tissue and avoiding tumor spillage.

Case Report: A five-year-old female presented with a 2-month history of right lower quadrant pain but no palpable mass. She had no signs of premature menarche or virilization to suggest hormonal activity. Serum tumor markers were negative. Abdominal ultrasound and MRI revealed a 3 cm calcified solid mass in the right ovary. We suspected a benign teratoma.

The patient was brought to the operating room. Under general anesthesia, she was positioned supine, in reverse Trendelenburg. The surgeon stood on the patient's left. The assistant stood on the patient's right and operated the camera. The monitor was at the foot of the bed. A 5 mm port was inserted at the umbilicus and pneumoperitoneum was obtained to pressure of 10 mmHg. A 5 mm 30-degree camera was placed through the umbilical port. A 5 mm port was inserted in the left lower quadrant and a 12 mm port was inserted in the supra-pubic skin crease for optimal triangulation.

The peritoneum around the right adnexa was incised with the Maryland dissector and a laparoscopic Debakey grasper. The blood supply to the ovary was not disturbed. It was mobilized, enclosed in an endobag and brought out through the 12 mm port site. The risk of tumor spillage was avoided.

The mass was separated from the normal ovarian tissue by hydro-dissection technique. A 30-gage needle was inserted under the ovarian visceral peritoneum and saline was injected slowly. A plane developed between the ovary and the peritoneum, as well as between the normal ovary and the mass. The peritoneum was circumferentially incised. Peanut dissection easily separated the mass from the normal ovarian tissue and it was removed intact. The ovary was then reconstructed by approximating the edges of the ovarian cortex with fine absorbable suture.

Ovarian attachments, the fallopian tube and blood supply were not disturbed. The structures were returned to the abdominal cavity. The left ovary appeared normal. No abnormalities were noted in the abdominal cavity. The abdomen was desufflated, the ports were removed and port sites were closed with absorbable suture. The pathologist confirmed a benign 3 cm teratoma, completely removed and intact.

Results: The operating time was 75 minutes. The patient was discharged on postoperative day 1 without complications. At follow-up evaluation, she is asymptomatic.

Conclusion: For pediatric patients with small solid ovarian tumors, and negative tumor markers, this video technique combines the advantages of laparoscopy with the principles of complete tumor removal, preservation of normal ovary and avoidance of tumor spillage.