Evolution of the surgical management of neonatal ovarian cysts: laparoscopic-assisted transumbilical extracorporeal ovarian cystectomy (LATEC)

Abstract

Purpose: Since its first detailed description in 1995, the laparoscopic management of neonatal ovarian cysts has typically required multiple incisions, specialized equipment, and advanced laparoscopic skills. After some initial frustration with neonatal laparoscopy, we developed a simplified single-incision laparoscopic-assisted transumbilical extracorporeal cystectomy (LATEC). This paper reviews our experience with this technique and compares outcomes to those of our other surgically managed neonatal ovarian cyst patients.

Materials and methods: A retrospective record review of 20 patients treated surgically between 1992 and 2006. Student's t-tests were used for comparisons (P<0.05 was significant).

Results: Means were: age, 11 days; weight, 3.7 kg; and cyst diameter, 5.0 cm. Nineteen patients were diagnosed prenatally, at the mean gestational age of 33 weeks. Twelve of 20 (60%) had torsed cysts (1 bilateral). Three of 13 torsed cysts (23%) were less than 4 cm diameter (range, 2.9-3.5). Laparotomies were transverse lower abdominal incisions. Laparoscopic operations used 2 (3 patients) or 3 incisions (2 patients). LATEC involved transumbilical laparoscopy, complete cyst aspiration, and then cyst evisceration through the umbilicus for either ovarian cystectomy (simple cysts) or salpingo-oophorectomy (torsed cysts). Laparoscopic patients had similar time to feeds, length of stay, and postoperative narcotic requirements, when compared to laparotomy patients (P=nonsignificant). LATEC patients had shorter surgical times, more rapid advancement to full enteral feedings, shorter length of hospital stay, and equal ovarian preservation, when compared to laparoscopy. Cosmetic results with LATEC were outstanding.

Conclusions: Both laparoscopic and "open" approaches have acceptable perioperative morbidity and rapid recovery. LATEC is a relatively simple procedure, which combines laparoscopy and traditional extracorporeal surgery, and may be successfully performed by experienced pediatric surgeons and with a single incision.

FIG. 1.

Laparoscopic-assisted transumbilical extracorporeal cystectomy technique with simple cyst delivery: (A) Cyst puncture (laparoscopic view). (B) Cyst decompression. (C) Cyst decompression (laparoscopic view).

FIG. 2.

Laparoscopic-assisted transumbilical extracorporeal cystectomy technique with torsed cyst and oophorectomy. (A) Cyst puncture/aspiration (laparoscopic view). (B) Delivery of the ovary by an umbilical incision. (C) Oophorectomy.