Single Incision Laparoscopic Resection of a Giant Ovarian Mature Cystic Teratoma

Abstract

Introduction:

Ovarian tumors in the pediatric population are a rare occurrence, with an incidence of 2.6 cases per 100,000 girls per year. ¹ Ovarian teratomas are germ cell tumors further categorized into mature and immature types. Mature cystic teratomas are the most common ovarian neoplasm, with a much lower risk of malignancy than immature teratomas. ² Frequently presenting in women during reproductive years, mature cystic teratomas often present with abdominal pain and distention. ³ Diagnosis is suggested by their characteristic appearance on ultrasonography and computed tomography (CT) scans. We present a video of a 13-year-old girl with an ovarian mature cystic teratoma resected using the single incision laparoscopic approach.

Case Report:

A 13-year-old girl presented with a 1-year history of abdominal fullness and a significantly protuberant abdomen on examination. Ultrasonoraphy and CT scans demonstrated a 32 × 15 × 27 cm cyst with calcifications, suggestive of a left ovarian cystic teratoma. The radiographic appearance and normal tumor markers (alpha fetoprotein and beta human chorionic gonadotropin) suggested a mature lesion with a low risk of malignancy. ⁴ Thus, we elected to perform a single incision laparoscopic resection through an umbilical incision. We initially suctioned 8 L of clear fluid from the cyst, which created adequate abdominal domain for laparoscopic resection. Given the extent of the cyst and effacement of the associated ovarian wall, an ovarian-sparing technique was unable to be performed. Examination of the mass after removal demonstrated three teeth within the cyst wall. The operative duration was 105 minutes. The patient tolerated the procedure well and was discharged home on the first postoperative day. Pathology analysis confirmed an ovarian mature cystic teratoma.

Discussion:

The laparoscopic approach to adnexal mass resection is considered the standard of care in the pediatric population. ⁵ There are cosmetic advantages as well as a decreased incidence of postoperative adhesion formation when compared with the open technique. ⁶ The single incision laparoscopic approach to adnexal masses has been described in adults and children. ^7,8 In a review of 19 pediatric patients with ovarian masses, for example, Lacher et al. demonstrated the safety and feasibility of this technique without complications, conversions, or readmissions.⁸ We believe that our video presentation is an important addition to the literature, given the impressive size of the mass and its effective resection through the single incision laparoscopic approach.

No competing financial interests exist.

Runtime of video: 3 mins 23 secs