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Piotrowska-Gall A, Strzelecka A, Wróbel J, Salamon A, Urbaniak-Wąsik S, Cierniak P, Wolak P. Laparoscopic Ovarian-Sparing Surgery for the Management of Benign Ovarian Lesions in Pediatric Patients: A Retrospective Analysis. J Pediatr Surg 2024; 59:400-406. [PMID: 37980197 DOI: 10.1016/j.jpedsurg.2023.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 10/20/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION Laparoscopic ovarian-sparing surgery (OSS) is safe and effective management approach for benign ovarian lesions in pediatric patients. This study evaluates the outcomes of females younger than 18 years who underwent the OSS procedure between December 2013 and November 2022 at a single institution. MATERIAL AND METHODS We conducted a retrospective analysis of records from 82 females who underwent OSS for ovarian lesions. OSS was performed based on diagnostic imaging that suggested the benign nature of the lesion. RESULTS Of the 82 patients studied, 78 had unilateral lesions and 4 had bilateral synchronous lesions. The mean age was 14 years. The majority (62 cases) of the surgeries were laparoscopic, with 20 requiring conversion to open surgery due to factors such as indistinguishable edges and large size of the lesion. We identified 8 cases of ovarian torsion. The surgical specimens revealed that 46 were ovarian teratomas, 2 were granulosa cell tumors, 15 were cystadenomas, and 23 were functional cysts. There were no intraoperative complications. Two recurrences were observed in patients who were initially treated for bilateral ovarian teratomas. One patient developed a pelvic abscess. Additionally, three patients had metachronous ovarian tumors during the follow-up period. In patients followed with ultrasound imaging, the viable ovary was visualized in 83.6% of the cases (61 out of 73). CONCLUSION Our findings demonstrate the effectiveness of laparoscopic OSS in preserving ovarian function and providing clinical benefits in patients with benign ovarian lesions. We recommend regular follow-up with ultrasound to exclude metachronous lesions or recurrence. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Aneta Piotrowska-Gall
- Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland; Department of Pediatric Surgery, Urology and Traumatology, Voivodship Hospital, Kielce, Poland.
| | | | - Joanna Wróbel
- Department of Pediatric Surgery, Urology and Traumatology, Voivodship Hospital, Kielce, Poland
| | - Aleksandra Salamon
- Department of Pediatric Surgery, Urology and Traumatology, Voivodship Hospital, Kielce, Poland
| | | | - Piotr Cierniak
- Department of Pediatric Radiology, Voivodship Hospital, Kielce, Poland
| | - Przemysław Wolak
- Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland; Department of Pediatric Surgery, Urology and Traumatology, Voivodship Hospital, Kielce, Poland
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Said H, Shafik Y, Faiz M, Bawazir O, Alhallaq O, Abdulmoez A, Al Dahshan Y. Single port laparoscopic-assisted ovarian cystectomy using optical forceps in neonates: a brief technical report. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00174-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The management of neonatal ovarian cysts is often demanding. However, offering surgery as a definitive treatment for patients who lack easy access to healthcare for follow-up is reasonable. Minimally invasive, ovary-sparing surgery provides benefits, including shorter operative times, hospital stay, and superior cosmesis. The novel modification described here renders added value because it utilizes readily available and reusable instruments, averts the need for multiple ports and large incisions, and is essentially time-saving.
So, the aim of the study is to evaluate the safety and feasibility and describe the use of optical forceps during single-port laparoscopic-assisted (SPLA) ovarian cystectomy in a specific cohort of neonates with simple/complicated ovarian cysts.
Results
Neonates who required ovarian cystectomy/salpingo-oophorectomy, admitted from January 2015 to December 2019 and fulfilled the inclusion criteria, were treated with optical forceps during SPLA. After the surgery, we put in place a follow-up protocol to monitor complications and recurrences.
Twenty-one neonates were included. The average gestational age was 37.2 ± 1.6 weeks, operative time was 43.2 ± 2.4 min, and length of hospital stay was 2.4 ± 0.5 days. In our experiment, there was no encounter with complications, recurrences, or ones that required conversion to laparotomy, nor did we require the use of extra ports.
Conclusion
SPLA procedures using optical forceps for managing neonatal cysts requiring surgery appear to be a safe and achievable option by allowing complete visualization of the cyst/lesion. It also has an excellent cosmetic result with a near-normal umbilicus scar. Further research is required to compare this method to open and laparoscopic standards.
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Toker Kurtmen B, Dokumcu Z, Divarci E, Ergun O, Ozok G, Celik A. Long-term surgical outcomes in pediatric ovarian neoplasms: 20-year single-center experience. Pediatr Surg Int 2022; 38:2035-2044. [PMID: 36169670 DOI: 10.1007/s00383-022-05256-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The management of pediatric ovarian neoplasms (ON) is based on finding a balance between adequate surgical treatment and future reproductive capacity. We aimed to evaluate long-term results of patients who underwent surgery for ON. METHODS A retrospective cohort study design was used. Medical records of patients with ON were reviewed. They were invited to participate in a telephone-based survey assessing complaints, menstrual status, and post-surgical recurrence. RESULTS Eighty-five patients were operated for ON between 1995 and 2015. Median age at surgery was 14.7 years. 62.4% of patients had ovary-sparing surgery (OSS). Median tumor size in oophorectomy group was significantly larger than OSS group (p = 0.029). Median length of follow-up was 5.1 years. Recurrent/metachronous disease was not significantly different between OSS and oophorectomy groups (p = 1.000). In OSS group, irregular menses (p = 0.004) and painful menses (p = 0.002) were significantly higher than oophorectomy group. CONCLUSION The main goal of treatment in pediatric ON is to find the right balance between adequate and appropriate tumor resection and maximal effort for fertility preservation. Our results showed no difference between oophorectomy and OSS in the terms of recurrence. Although irregular and painful menses were found to be significantly higher in the OSS group, longer follow-up and prospective studies are needed to clarify this issue.
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Affiliation(s)
- Bade Toker Kurtmen
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Bornova, 35100, İzmir, Turkey
| | - Zafer Dokumcu
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Bornova, 35100, İzmir, Turkey
| | - Emre Divarci
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Bornova, 35100, İzmir, Turkey
| | - Orkan Ergun
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Bornova, 35100, İzmir, Turkey
| | - Geylani Ozok
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Bornova, 35100, İzmir, Turkey
| | - Ahmet Celik
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Bornova, 35100, İzmir, Turkey.
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Xu D, Gao H, Yu S, Huang G, Lu D, Yang K, Zhang W, Zhang W. Ensuring safety and feasibility for resection of pediatric benign ovarian tumors by single-port robot-assisted laparoscopic surgery using the da Vinci Xi system. Front Surg 2022; 9:944662. [PMID: 36061048 PMCID: PMC9437548 DOI: 10.3389/fsurg.2022.944662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background Single-port robot-assisted laparoscopic surgery (S-RALS) is rarely applied in pediatric surgery. There is still no study on the application of S-RALS for resection of pediatric benign ovarian tumors. The current study aimed to investigate the safety and feasibility of S-RALS for resection of pediatric benign ovarian tumors using the da Vinci Xi system. Methods The clinical data of three patients who underwent S-RALS for resection of benign ovarian tumors in the Department of Pediatric Surgery, Zhongnan Hospital of Wuhan University from May 2020 to September 2021 were retrospectively analyzed. The mean age of these children was 7.9 years (5.8–9.3 years). One was a case of bilateral ovarian tumors, and the other two were cases of right ovarian tumors. Results All three patients successfully underwent the resection of ovarian tumors through S-RALS without conversion to laparotomy. The average operation time was 180 min (118–231 min). The average amount of blood loss was 20 ml (10–35 ml). No drainage tube was placed. All postoperative pathological types of ovarian tumors were mature cystic teratomas in the three cases. All patients started a liquid diet 2 h after surgery. The average length of postoperative hospital stay was 4.7 days (3–7 days). No tumor recurred, no surgical site hernia occurred, and the wound healed very well with a cosmetic scar in the lower umbilical crease during the postoperative follow-up for 6–18 months. Conclusion S-RALS has the advantages of less surgical trauma, quick postoperative recovery, and a cosmetic scar in the lower umbilical crease. It is safe, effective, and feasible for pediatric benign ovarian tumors.
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Affiliation(s)
- Deqiang Xu
- Department of Pediatric Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Heyun Gao
- Department of Pediatric Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shanzhen Yu
- Department of Pediatric Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Guangbin Huang
- Department of Pediatric Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Dan Lu
- Department of Ultrasound Imaging, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Kun Yang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Zhang
- Department of Gynaecology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wen Zhang
- Department of Pediatric Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Correspondence: Wen Zhang
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Rasp E, Saavalainen L, But A, Gissler M, Härkki P, Heikinheimo O, Rönö K. Surgically confirmed endometriosis in adolescents in Finland-A register-based cross-sectional cohort study. Acta Obstet Gynecol Scand 2022; 101:1065-1073. [PMID: 35818936 PMCID: PMC9812065 DOI: 10.1111/aogs.14419] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/05/2022] [Accepted: 06/18/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Increasing awareness of endometriosis in adolescents requires data on the nature of the disease and its management. Our objective was to investigate the subtypes of surgically confirmed endometriosis in adolescents (aged <20 years) and trends in the incidence rates and endometriosis-related procedures during the study period, 1987-2012. MATERIAL AND METHODS In this register-based cohort study, we identified 526 adolescents receiving their initial surgical diagnosis of endometriosis between 1987 and 2012 from the Finnish Hospital Discharge Register. The age-specific incidence rate of surgically confirmed endometriosis was calculated by dividing the number of adolescents during specific periods by person-years. We calculated the relative differences in incidence rates between the periods using crude incidence ratios. RESULTS Adolescents were divided into three age groups, <17, 17-18, and 19 years, which comprised 8.2% (43/526), 39.7% (209/526), and 52.1% (274/526) of the study cohort, respectively. Peritoneal endometriosis and ovarian endometriosis were the most common types (379/526 [72%] and 119/526 [23%], respectively). The incidence rate of surgically confirmed endometriosis per 100 000 person-years varied from 5.63 (95% confidence interval [CI] 4.24-7.33) to 11.42 (95% CI 9.64-13.44). The incidence rate in 2001-2005 was significantly higher and was 1.6- to 2.0-fold that of the periods 1987-1990 and 2006-2012, respectively. Comparing the periods in which International Classification of Diseases, Ninth Revision (ICD-9; 1987-1995) and Tenth Revision (ICD-10; 1996-2012) codes were used, the use of laparoscopy (78.2% vs 88.9%), day surgery (10.3% vs 31.6%), and procedures for ovarian (18.8% vs 34.1%) and deep (0.6% vs 10.8%) endometriosis increased. The types of endometriosis and procedures did not differ between the age groups. CONCLUSIONS Peritoneal endometriosis was the most common type of endometriosis overall and by age group. During the 26-year period, the incidence rate of initial surgical diagnosis of endometriosis peaked in 2001-2005 and decreased thereafter. The proportion of procedures performed for ovarian and deep endometriosis increased, as did the use of laparoscopy and day surgery.
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Affiliation(s)
- Elina Rasp
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Liisu Saavalainen
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Anna But
- Biostatistics consulting, Department of Public HealthUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Mika Gissler
- Finnish Institute for Health and Welfare (THL)HelsinkiFinland,Academic Primary Health Care CenterRegion StockholmStockholmSweden,Department of Molecular Medicine and SurgeryKarolinska InstituteStockholmSweden
| | - Päivi Härkki
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Oskari Heikinheimo
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Kristiina Rönö
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
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Stefanopol IA, Baroiu L, Chirila S, Miulescu M, Anghel L, Nechita L, Dinu CA, Stefanescu V, Bobeica C, Nechifor A, Tatu AL. The Influence of Living in Rural Areas on the Evolution and Management of Pediatric Ovarian Cystic Lesions: A Retrospective Study on a Cohort from South Eastern Romania. Int J Gen Med 2022; 15:5273-5284. [PMID: 35655655 PMCID: PMC9153997 DOI: 10.2147/ijgm.s368202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ioana Anca Stefanopol
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Department of Pediatric Surgery and Orthopedy, “Sf Ioan” Clinical Emergency Hospital for Children, Galati, Romania
| | - Liliana Baroiu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Infectious Diseases Department, “Sf. Cuvioasa Parascheva” Clinical Hospital of Infectious Diseases, Galati, Romania
- Correspondence: Liliana Baroiu, Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, 47 Domnească Street, Galati, 800010, Romania, Tel +40723201241, Email
| | - Sergiu Chirila
- Medical Informatics and Biostatistics, Faculty of Medicine, Ovidius University, Constanta, Romania
- Sergiu Chirila, Medical Informatics and Biostatistics, Faculty of Medicine, Ovidius University, 1 University Alee, Campus B, Constanta, 900470, Romania, Tel +407213320668, Email
| | - Magdalena Miulescu
- Research Center in the Functional Cardiorespiratory and Neuromotor Exploration, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, Romania
| | - Lucreţia Anghel
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Internal Medicine Department, “sf Andrew the Apostle” County Emergency Clinical Hospital, Galati, Romania
| | - Luiza Nechita
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Ciprian Adrian Dinu
- Dental Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Victorita Stefanescu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Carmen Bobeica
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Alexandru Nechifor
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Alin Laurenţiu Tatu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Research Center in the Field of Medical and Pharmaceutical Sciences, Reform-UDJ, Galati, Romania
- Dermatology Department, “Sf. Cuvioasa Parascheva” Clinical Hospital of Infectious Diseases, Galati, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC DIR, Galati, Romania
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Arthur F, Hennessey I, Pizer B, Losty PD. Surgical management and outcomes of paediatric ovarian tumours-a 25-year UK single centre experience. Pediatr Surg Int 2021; 37:1355-1359. [PMID: 34170394 DOI: 10.1007/s00383-021-04950-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ovarian neoplasms in children are rare heterogeneous lesions with variable biological behaviour and outcome. We herein report a 25-year experience from a UK specialist centre managing paediatric ovarian tumours. METHODS All female patients requiring operation for ovarian tumours were identified during the study period 1990-2018. Patient demographics, clinical presentation, and management are highlighted. RESULTS Eighty-eight females with 101 ovarian tumours including cases with synchronous and metachronous neoplasms were documented. Mean age at diagnosis was 11.8 years. Tumours were equally distributed in left and right ovary(s). Bilateral disease occurred in 11 (10.8%) patients. Eighty-six (85%) neoplasms were benign and 15 (15%) malignant requiring in addition to surgery chemotherapy and/or radiation. There were no significant difference(s) observed in maximum tumour diameter in benign vs malignant lesions. Only half of malignant tumours had positive tumour markers. Fifteen patients (15%) had ovarian lesions that were metastatic at primary presentation including a rare case of disseminated peritoneal gliomatosis. Surgical management included salpingo-oopherectomy n = 21 (21%), ovary excision n = 33 (33%), 'ovary sparing' tumourectomy n = 34 (34%), and cyto-reductive extirpation in 2 cases (2%). Lymphadenectomy was performed in 9 patients (9%) together with peritoneal fluid cytology in 18 cases (18%) who had abdominal ascites. Omentectomy was required in 14 patients (14%), multiple peritoneal biopsy(s)-in 11 cases (11%) and biopsy of other suspicious involved organs notably bowel, gut mesentery and contralateral ovary in 7 (7%) further patients. Recurrent and metachronous lesions occurred in 10 (10%) cases in those with teratoma (n = 9) and adenocarcinoma(s) (n = 1). Overall patient survival was 97% with only 3 deaths-mucinous cystadenocarcinoma (n = 1), desmoplastic small round cell tumour of ovarian origin (n = 1), and a small cell carcinoma of ovary with hypercalcaemia (n = 1). CONCLUSIONS Findings from this study show an excellent survival (97%) for paediatric ovarian neoplasms. Rare malignant neoplasms though do carry a poor prognosis. In the modern era of care, all efforts should be made to preserve future hormonal health and fertility with 'ovarian sparing' operation(s) where appropriate.
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Affiliation(s)
- Felicity Arthur
- Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Iain Hennessey
- Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Barry Pizer
- Department of Paediatric Oncology, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK.,School of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Paul D Losty
- Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK. .,School of Health and Life Sciences, University of Liverpool, Liverpool, UK.
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Roos EJ, Simms-Cendan J, Cheung C, Laufer D, Grover SR. Pediatric and adolescent gynecology through a global lens. Int J Gynaecol Obstet 2021; 156:189-196. [PMID: 33905533 DOI: 10.1002/ijgo.13723] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/13/2021] [Accepted: 04/22/2021] [Indexed: 11/09/2022]
Abstract
Girls and adolescents, aged 0-19 years make up almost 30% of the world's female population yet their specific healthcare needs often slip between the gaps of pediatrics and adult women's health. Pediatric and adolescent gynecology is the clinical field that endeavors to address the reproductive health needs of this age group. The environment and psychosocial well-being, social determinants of health, have direct bearing on reproductive health, affecting menstrual cycles, menstrual hygiene, and risks for unintended pregnancy and sexually transmitted infections. This narrative review will highlight common gynecologic conditions of adolescents, especially where diagnosis and management are distinct from adult women. It will also present preventive health strategies to improve reproductive health through vaccination, improved access to hygiene supplies and contraception.
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Affiliation(s)
- Eveline J Roos
- Department of Obstetrics and Gynecology, Tergooi, The Netherlands
| | | | - Charleen Cheung
- Department of Obstetrics and Gynecology, Queen Mary Hospital, Hong Kong
| | | | - Sonia R Grover
- Department of Gynecology, Royal Children's Hospital, Murdoch Children's Research Institute and University of Melbourne, Melbourne, Vic., Australia
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Raźnikiewicz A, Korlacki W, Grabowski A. The role of laparoscopy in paediatric and adolescent gynaecology. Wideochir Inne Tech Maloinwazyjne 2020; 15:424-436. [PMID: 32904632 PMCID: PMC7457195 DOI: 10.5114/wiitm.2020.97817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 06/07/2020] [Indexed: 12/03/2022] Open
Abstract
Paediatric and adolescent gynaecology is a narrow field of medicine dealing with the diagnosis of and treatment of gynaecological diseases from the neonatal period to sexual maturity. The current trend in surgical gynaecology in the paediatric population is to minimise the degree of invasiveness of diagnostic and therapeutic procedures. This contributes to reducing the number of complications and the risk of infertility. Laparoscopic procedures are a challenge for paediatric surgeons and gynaecologists, not only because of the age of treated patients, and anatomical and physiological differences between different age groups but also because of the complexity of the pathology, the differentiation of cancer tumours, and the presence of congenital developmental defects.
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Affiliation(s)
- Aleksandra Raźnikiewicz
- Department of Children's Developmental Defects Surgery and Traumatology, Medical University of Silesia, Katowice, Poland
| | - Wojciech Korlacki
- Department of Children's Developmental Defects Surgery and Traumatology, Medical University of Silesia, Katowice, Poland
| | - Andrzej Grabowski
- Department of Children's Developmental Defects Surgery and Traumatology, Medical University of Silesia, Katowice, Poland
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