Operative techniqueTransumbilical management for neonatal ovarian cysts
Section snippets
Materials and methods
From May 2000 to December 2006, 6 female newborns with ovarian cysts were treated via the transumbilical route. All patients were detected by prenatal ultrasound scan and referred to our institution after birth. Postnatal ultrasound was performed in all cases, and one case with initial diagnosis of teratoma received an additional computed tomographic scan. Indications for surgery are large symptomatic simple cyst and complex cyst diagnosed by ultrasound and, if necessary, computed tomographic
Results
All infants were full term (Table 1). The cysts were simple in 3 cases, whereas the other 3 cases were complex. Average size was 8.1 cm (range, 6.7-9.5 cm) for the simple cysts and 5.6 cm (range, 4.5-6.7 cm) for the complex cysts. Cases 1 and 3 developed respiratory distress owing to the mass effect of large cystic size after birth, and case 1 even needed emergent intubation. The average age at operation was 8.5 days (range, 2-20 days). The mean operating time was 27.6 minutes (range, 21-43
Discussion
After the introduction of ultrasound for the routine monitoring of pregnancy, the incidence of ovarian cysts progressively increased. Thus, the natural course of ovarian cysts has become clearer. Cysts smaller than 4 to 5cm in diameter tend to regress or resolve spontaneously in 3 to 4 months [2], [3]; and the incidence of torsion is low, although it has occurred in cysts as small as 2 cm [4]. According to the previous reports [2], [5], [6], cysts with a diameter larger than 5 cm and a volume
Conclusions
Our initial results suggest that transumbilical management for neonatal ovarian cysts is feasible. The technique is easy, and surgical exposure is adequate. It offers a good cosmetic appearance like other minimally invasive procedures. Although no complication has been found until now, more cases are needed for further investigation.
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Cited by (26)
The Role of Surgery in Antenatal Ovarian Torsion: Retrospective Evaluation of 28 Cases and Review of the Literature
2022, Journal of Pediatric and Adolescent GynecologyCitation Excerpt :In 2007 Lin et al described the transumbilical management of neonatal ovarian cysts. They successfully treated 2 AOTs with mini-laparotomy in their series.43 However, since the first reported case of laparoscopically treatment, approximately 50% of the reported cases are still treated using laparotomy.
A new paradigm of scarless abdominal surgery in children: Transumbilical minimal incision surgery
2014, Journal of Pediatric SurgeryCitation Excerpt :Soutter reported 42 infants (less than 24 months of age) who had undergone the transumbilical approach for duodenal atresia/stenosis/web, malrotation, intestinal atresia/stricture, etc. [3]. The use of the transumbilical approach for neonatal laparotomy has been reported previously [4,7–9]. Our institution has improved the technique for minimally invasive surgery in children.
Neonatal surgery for giant floating abdominal cysts in females: Clinical and surgical management
2014, Journal of Pediatric and Adolescent GynecologyCitation Excerpt :In recent studies some authors reported their experience with complex ovarian cysts managed conservatively, but this approach represents a successful option only if the diagnosis is clear and certain; nothing is reported in literature about the management of giant cysts.6 Giant abdominal cysts are reported to have torsion as their most common complication but also rupture of the cyst itself and gastro-intestinal obstruction or perforation are reported.7–10 In the absence of complications (ie, respiratory distress, enlarged abdomen or compression of the adjacent organs) a less aggressive approach is possible and desirable even with larger cysts; this approach involves needle aspiration of the content of the cyst during the first days of life.
A comparison of circumumbilical and transverse abdominal incisions for neonatal abdominal surgery
2011, Journal of Pediatric SurgeryCitation Excerpt :In this study, however, the fascial incision was made vertically rather than horizontally, and operative time was significantly longer in the circumumbilical group as compared with the transverse abdominal group. More recently, several authors have described the use of a circumumbilical incision in the management of complicated neonatal surgical conditions including duodenal or intestinal atresias/web, malrotation, intestinal stricture, necrotizing entercolitis with perforation, meconium ileus, intestinal duplication cyst, Hirschsprung disease, and ovarian cyst [2-7]. These studies have documented that the circumumbilical incision is an effective, safe, and cosmetically superior approach to the standard transverse laparotomy in neonatal abdominal surgery.
Comparison between transumbilical and transabdominal ports for the laparoscopic retrieval of benign adnexal masses: A randomized trial
2010, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :In 1986, Tan and Bianchi reported using a circumumbilical incision as the access for pyloromyotomy in infantile hypertrophic pyloric stenosis and the removal of neonatal ovarian cyst [11]. A small umbilical incision is large enough to allow adequate exposure and offers a good postsurgical cosmetic appearance [11–13]. No bleeding or herniation has been noted.