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Laparoscopic approach for gonadectomy in pediatric patients with intersex disorders
Andres Calvo1, Maria Escolino2, Alessandro Settimi2
1Department of Pediatric Surgery, Pediatric Children Hospital, Cordoba, Argentina.
Insights
Laparoscopic gonadectomy is a safe and effective treatment for children with disorders of sex development (DSD), offering reduced complications and excellent cosmetic results. This minimally invasive approach eliminates cancer risks and aids in diagnosing gonadal tumors.
Area of Science:
- Pediatric Urology
- Endocrinology
- Surgical Oncology
Background:
- Disorders of Sex Development (DSD) require long-term, multidisciplinary management, with individualized surgical approaches crucial due to rare occurrences and anatomical variations.
- Gonadectomy is often indicated for DSD with a Y chromosome to mitigate cancer risk, but optimal timing and indications remain debated.
- Laparoscopy is increasingly utilized in pediatric urology for its minimally invasive nature and cosmetic benefits.
Approach:
- A comprehensive literature review of the past 10 years was conducted to evaluate the role of laparoscopic gonadectomy in DSD patients.
- The review analyzed studies focusing on the safety, efficacy, and outcomes of laparoscopic procedures for DSD management.
- Data on intra-operative and post-operative complications, as well as the incidence of gonadal tumors, were extracted and synthesized.
Key Points:
- Laparoscopic gonadectomy procedures in the reviewed literature were consistently successful, with no conversions to open surgery or intra-operative complications reported.
- Post-operative complications were minimal, including rare instances of infection and abscess, both successfully treated with antibiotics.
- A significant finding was the detection of gonadal tumors (gonadoblastoma, dysgerminoma, seminoma) in 10-33% of patients, highlighting the importance of gonadectomy in cancer risk reduction.
Conclusions:
- The review confirms the safety and efficacy of laparoscopic gonadectomy as a treatment for DSD.
- Laparoscopic gonadectomy is recommended as the preferred treatment for children and adolescents with DSD, offering minimal invasiveness, reduced morbidity, faster recovery, and superior cosmetic outcomes.
- This approach effectively addresses the risk of gonadal malignancies in DSD patients.
Abstract:
The birth of a child with a disorder of sex development (DSD) prompts a long-term management strategy that involves a myriad of professionals working with the family. There has been progress in diagnosis, surgical techniques and in understanding psychosocial issues related to this condition. However, since these kinds of disorders are rare and have many anatomical variations, individual care is necessary, especially regarding surgical management. Gonadectomy is indicated in a number of intersex disorders with a Y chromosome to reduce the associated risk of cancer. Recently, laparoscopy has gained wide acceptance in pediatric urology. Laparoscopy is also reported to be a useful tool for diagnosing and treating DSD because of its minimal invasiveness and favorable cosmetic outcome. However, reports of evaluation and management using laparoscopy for large numbers of DSD patients are limited and debate is still open about indications and timing of gonadectomy. In this study, we reviewed the literature of the last 10 years about the role of laparoscopic gonadectomy in patients with DSD. In the analyzed papers, all the procedures were accomplished successfully using laparoscopy. No conversions to open surgery neither intra-operative complications were reported in all series. Post-operative complications were reported only in one series and included 1 umbilical port infection [2% (1/50)] and 1 pelvic abscess [2% (1/50)], both treated with antibiotic therapy (grade I Clavien-Dindo). Of the analyzed series, 7/10 reported postoperative diagnosis of gonadal tumors. The histopathologic examinations revealed 15 cases of gonadoblastoma, 7 cases of dysgerminoma and 2 cases of seminoma. Analyzing the single series, the incidence of these tumors varied between 10% and 33%. The results of our review confirmed the safety and efficacy of laparoscopic gonadectomy in DSD patients. In our mind, laparoscopic gonadectomy should be accepted as the treatment of choice in children and adolescents with these rare conditions. It thereby eliminates the risk of malignancies of gonadal origin with the advantages of a minimally invasive procedure, with lower morbidity, quicker postoperative recovery and excellent cosmetic results.
