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Improving Minimally Invasive Surgical Approaches to Large Adnexal Masses in Pediatric Gynecology: Combining
Megan F Sumida1, Olivia K Winfrey1, Julie Hakim1
1Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; Division of Pediatric and Adolescent Gynecology, Texas Children's Hospital, Houston, Texas.
Insights
Pediatric ovarian cysts can be treated with a minimally invasive technique combining laparoscopy and mini-laparotomy. This approach allows for ovarian preservation and same-day discharge in young patients.
Area of Science:
- Pediatric Surgery
- Gynecologic Oncology
- Minimally Invasive Surgery
Background:
- Large ovarian cysts in children are frequently benign.
- Minimally invasive surgery is preferred for pediatric ovarian cysts to reduce pain, speed recovery, and improve cosmetic outcomes.
- Ovarian preservation (cystectomy) is prioritized over removal (oophorectomy).
Purpose of the Study:
- To describe a novel surgical technique for pediatric ovarian cysts.
- To evaluate the safety and efficacy of a combined diagnostic laparoscopy and mini-laparotomy approach using the GelPOINT Mini™ platform.
- To assess the feasibility of same-day discharge and ovarian preservation in pediatric patients with large ovarian cysts.
Main Methods:
- A case series of pediatric patients (aged 3-16 years) with large ovarian cysts (7-24 cm) and benign preoperative risk stratification.
- Surgical technique involved diagnostic laparoscopy and mini-laparotomy via the GelPOINT Mini™ Advanced Access Platform for single-site surgery.
- All patients underwent ovarian-sparing surgery.
Main Results:
- Successful surgical intervention for large ovarian cysts in pediatric patients.
- All surgeries were completed with ovarian preservation.
- Patients experienced same-day discharge, benefiting from both open and laparoscopic approaches.
- The technique was applied to cysts ranging from 7 to 24 cm.
Conclusions:
- The combined diagnostic laparoscopy and mini-laparotomy technique using the GelPOINT Mini™ platform is effective for treating large ovarian cysts in pediatric patients.
- This approach facilitates ovarian preservation and allows for same-day discharge.
- The technique offers the advantages of both open and laparoscopic surgery in a minimally invasive, single-site procedure.
Abstract:
In pediatric populations large ovarian cysts are often benign, and minimally invasive approaches are preferred to minimize perioperative pain and recovery, allow for same day discharge, and improve incision cosmesis. Ovarian preservation is also prioritized and cystectomy is preferred over oophorectomy. While tactile sensation and dexterity are improved in mini laparotomy cases, there are limitations with visualization that are improved with laparoscopy. We describe a technique that employs both diagnostic laparoscopy and mini laparotomy using the GelPOINT Mini™ Advanced Access Platform for single site laparoscopy in pediatric patients. This case series includes cysts ranging 7-24 cm with benign preoperative risk stratification, in patients aged 3-16 years, who underwent successful same-day, ovarian-sparing surgery with the benefits of both open and laparoscopic procedures.
