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Laparoscopic management of müllerian duct cysts in infants
Alireza Aminsharifi1, Firoozeh Afsar, Sara Pakbaz
1Department of Urology, Laparoscopic Research Center, Stem Cell And Transgenic Technology Research Center, Shiraz University of Medical Sciences, 71344 Shiraz, Iran. aminsharifi_ar@yahoo.com
Insights
Laparoscopic excision of pelvic müllerian duct cysts (MDCs) in infants is feasible. This minimally invasive approach offers excellent surgical visualization for these rare pelvic masses.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Urology
Background:
- Müllerian duct cysts (MDCs) are rare pelvic masses in infants.
- These cysts can cause significant complications like urinary retention and hydroureteronephrosis.
Observation:
- Two infants, a 3-month-old female and a 13-month-old male, presented with symptoms of urinary retention due to large retrovesical cystic pelvic masses.
- Preoperative imaging revealed hydroureteronephrosis in both infants.
Findings:
- Transperitoneal laparoscopic excision of the pelvic MDCs was successfully performed in both infants.
- Histopathology confirmed the masses as MDCs.
- Postoperative follow-up showed no recurrence and resolution of hydroureteronephrosis, with normal bladder function in the male infant.
Implications:
- Laparoscopic excision of pelvic MDCs in infants is technically feasible and provides excellent surgical exposure.
- This minimally invasive technique may offer reduced morbidity compared to open procedures.
- Further long-term follow-up is needed to confirm the benefits of laparoscopic MDC excision.
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.
