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Saxena AK, Mutanen A, Gorter R, Conforti A, Bagolan P, De Coppi P, Soyer T. European Paediatric Surgeons' Association Consensus Statement on the Management of Neonatal Ovarian Simple Cysts. Eur J Pediatr Surg 2024; 34:215-221. [PMID: 37557903 DOI: 10.1055/s-0043-1771211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
INTRODUCTION Neonatal ovarian simple cyst management from the pediatric surgical aspect is unclear on cyst size, follow-up, and preferred surgical approach. Therefore, this topic was selected for the 2022 Consensus Session meeting of the European Paediatric Surgeons' Association (EUPSA). METHODS The literature was reviewed on a predefined set of questions relating to the management of the neonatal ovarian simple cysts by a panel of 7 EUPSA members, on current evidence-based opinion and practice outlined. Each question (1) outcomes of fetal interventions in neonates after birth and consensus on size/timing of intervention, (2) consensus on the type of interventions, and (3) complications in neonatal ovarian cysts and follow-up recommendations in nonoperated/operated cysts, was presented with available evidence to congress session participants. The management approach was agreed by participants and comments were accounted to formulate the consensus statement. RESULTS There is still limited data on potential benefits and complications of prenatal ultrasound-guided aspiration; however, neonates after such procedures should be followed for 6 months. Neonates with simple ovarian cysts larger than 4 cm should be offered surgical interventions within the 2 weeks of life with complete laparoscopic cyst aspiration and fenestration with bipolar instruments being the preferred approach. Ultrasound follow-up after surgical intervention after 3 months and with the conservative approach after every 3 to 4 months until 1 year. CONCLUSION A peer-reviewed consensus statement for the management of neonatal ovarian simple cyst was formulated based on current evidence and peer practice. The EUPSA recognizes that the statement can be useful for pediatric surgeons in decision making for this pathology.
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Affiliation(s)
- Amulya K Saxena
- Department of Pediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Annika Mutanen
- Department of Pediatric Surgery, University of Helsinki Children's Hospital, Helsinki, Finland
| | - Ramon Gorter
- Department of Pediatric Surgery, Emma Children's Hospital UMC, Amsterdam, the Netherlands
| | - Andrea Conforti
- Department of Medical and Surgical Neonatology, Bambino Gesu' Children's Hospital, Rome, Italy
| | - Pietro Bagolan
- Department of Medical and Surgical Neonatology, Bambino Gesu' Children's Hospital, Rome, Italy
| | - Paolo De Coppi
- Department of Paediatric Surgery, UCL Institute of Child Health, London, United Kingdom of Great Britain and Northern Ireland
- Department of Surgery, Great Ormond Street Hospital for Children, London, United Kingdom of Great Britain and Northern Ireland
| | - Tutku Soyer
- Department of Pediatric Surgery, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
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Min J, Tang R, Zhi W, Gu Z, Huang S, Wang J. Clinical outcomes of fetal ovarian masses diagnosed by prenatal ultrasonography and literature review. Medicine (Baltimore) 2022; 101:e30962. [PMID: 36254031 PMCID: PMC9575801 DOI: 10.1097/md.0000000000030962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
With the advancement of prenatal examination technology, more and more fetus with ovarian masses are diagnosed. However, whether such children need intervention measures after delivery, there is no more unified diagnosis and treatment measures in the world. In this study, postnatal data and clinical outcome of fetal diagnosed with ovarian masses were analyzed. We also combined with relevant literature to explore the postpartum intervention measures and timing of such children. A total of 57 cases of abdominal masses from the reproductive system were included in the study. These children were diagnosed with ovarian masses after birth. We collected from 2012 to 2020, the prenatal examination revealed the presence of abdominal masses from the reproductive system, and diagnosis was confirmed by imaging examinations after childbirth. We counted the fetal period data of these children, compared the changes in the postnatal pathology and intervention measures. A total of 57 cases of ovarian masses were diagnosed prenatally, 1 case was lost to follow-up, and 56 cases were finally included in the study. After birth a total of 21 cases of ovarian masses were treated conservatively, of which 18 cases resolved spontaneously during the follow-up process, with an average follow-up period of 30.88 ± 18.16 weeks. There were statistically significant differences in the nature and the maximum diameter of the mass between the two groups receiving conservative treatment or surgical treatment after delivery (P < .05).Univariate and multivariate Logistic regression analysis showed that there were significant differences in the nature and diameter of the mass between two groups (P < .05). In addition, we divided the children undergoing postpartum surgery into a laparoscopic surgery group and a conventional open surgery group. Through data analysis, we found that there were statistically significant differences in the age of operation, operation time, and hospitalization days in the two groups of these children (P < .05). Children diagnosed with ovarian masses prenatally generally have a good prognosis. For these children, the treatment plan should be developed according to the child general condition. If child with ovarian mass is treated with surgery, the preservation of ovarian tissue should be emphasized regardless of the size, nature, and torsion of the mass.
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Affiliation(s)
- Jie Min
- Department of Pediatric Surgery, Children’s Hospital of Soochow University, Suzhou, China
| | - Ruze Tang
- Department of Pediatric Surgery, Children’s Hospital of Soochow University, Suzhou, China
| | - Wenxian Zhi
- Department of Pediatric Surgery, Children’s Hospital of Soochow University, Suzhou, China
| | - Zhicheng Gu
- Department of Pediatric Surgery, Children’s Hospital of Soochow University, Suzhou, China
| | - Shungen Huang
- Department of Pediatric Surgery, Children’s Hospital of Soochow University, Suzhou, China
| | - Jian Wang
- Department of Pediatric Surgery, Children’s Hospital of Soochow University, Suzhou, China
- *Correspondence: Jian Wang, Department of Pediatric Surgery,Children’s Hospital of Soochow University, Suzhou 215123, China (e-mail: )
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Abstract
BACKGROUND Because of the restricted space of the peritoneal cavity and the easy mobility of abdominal and pelvic organs in infants and neonates, the boundary of minimally invasive surgery was extended to complete the operation outside the abdomen. The objective of this study was to report our experience with transumbilical laparoscopic-assisted surgery (TULS) in different abdominal pathologies in infants and neonates. PATIENTS AND METHODS A retrospective study was conducted on 59 patients who underwent TULS from 2014 to 2020. The study outcomes were the conversion to open approach, length of hospital stay and post-operative complications. RESULTS The most common indications were explorations for intra-abdominal testes (n = 15) and inguinal herniorrhaphy (n = 13). Patients who had surgery for pyloric stenosis were younger (1.03 ± 0.25 months). The average operative time was 45.9 ± 18.39 min. The longest operative time was reported with surgery for liver cysts (94.5 ± 10.6 min). Oral intake was started after 48-56 h in patients who had excision of duplication cysts. The average post-operative hospital stay was 2.6 ± 1.52 days. No major complications were reported. Wound infection occurred in one patient with a duplication cyst. Three patients were converted to open repair (5.1%) and no late complications were reported during the mean follow-up time of 11.2 ± 5.1 months. CONCLUSIONS The transumbilical approach is a safe alternative method to laparotomy in several abdominal pathologies in infants and neonates. It has a short operative time and hospital stay. The technique is associated with few complications and conversion rates.
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Affiliation(s)
- Osama Abdullah Bawazir
- Department of Surgery, Faculty of Medicine, Umm Al-Qura University, Makkah; Department of Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, KSA
| | - Razan Bawazir
- Medical Student, Medical College, King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Jeddah, KSA
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Laparoscopic Excision of Large Intra-Abdominal Cysts in Children: Needle Hitch Technique. Case Rep Med 2016; 2015:937191. [PMID: 26798349 PMCID: PMC4698560 DOI: 10.1155/2015/937191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 12/08/2015] [Indexed: 01/22/2023] Open
Abstract
Laparoscopic surgery has both diagnostic and therapeutic advantages in the management of intra-abdominal cysts in children. Large cysts in small children pose technical challenges during laparoscopic surgery, requiring multiple incisions and advanced laparoscopic skills. This paper describes a novel laparoscopic technique using minimal manipulation for both aspiration and excision of the cyst. This simple, safe, and effective approach was used to achieve traction and facilitate excision of a large intra-abdominal cyst in a neonate and a young child.
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Single-Incision Single-Instrument Adnexal Surgery in Pediatric Patients. Minim Invasive Surg 2015; 2015:246950. [PMID: 26557994 PMCID: PMC4617692 DOI: 10.1155/2015/246950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/01/2015] [Accepted: 09/02/2015] [Indexed: 01/30/2023] Open
Abstract
Introduction. Pediatric surgeons often practice pediatric gynecology. The single-incision single-instrument (SISI) technique used for appendectomy is applicable in gynecologic surgery. Methods. We retrospectively analyzed the records of patients undergoing pelvic surgery from 2008 to 2013. SISI utilized a 12 mm transumbilical trocar and an operating endoscope. The adnexa can be detorsed intracorporeally or extracorporealized via the umbilicus for lesion removal. Results. We performed 271 ovarian or paraovarian surgeries in 258 patients. In 147 (54%), the initial approach was SISI; 75 cases (51%) were completed in patients aged from 1 day to 19.9 years and weighing 4.7 to 117 kg. Conversion to standard laparoscopy was due to contralateral oophoropexy, solid mass, inability to mobilize the adnexa, large mass, bleeding, adhesions, or better visualization. When SISI surgery was converted to Pfannenstiel, the principal reason was a solid mass. SISI surgery was significantly shorter than standard laparoscopy. There were no major complications and the overall cohort had an 11% minor complication rate. Conclusion. SISI adnexal surgery is safe, quick, inexpensive, and effective in pediatric patients. SISI was successful in over half the patients in whom it was attempted and offers a scarless result. If unsuccessful, the majority of cases can be completed with standard multiport laparoscopy.
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Management of neonatal ovarian cysts and its effect on ovarian preservation. J Pediatr Surg 2014; 49:990-3; discussion 993-4. [PMID: 24888849 DOI: 10.1016/j.jpedsurg.2014.01.040] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 01/27/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE Management of asymptomatic neonatal ovarian cysts varies. Some surgeons advocate initial observation, while others recommend immediate operation depending on cyst size and complexity. This study aims to compare outcomes of initial observation versus primary surgery, focusing on incidence of postnatal torsion and ovarian preservation. METHODS A retrospective study (1997-2012) of neonates with an ovarian mass was performed. Data on cyst size, ultrasound characteristics, clinical course, complications, and pathology were extracted. RESULTS Thirty-seven neonates with asymptomatic ovarian cysts were identified (N=25 observed, N=12 primary surgery). Overall, 12/25 (48%) observed had successful cyst regression, including 3/8 (38%) cysts ≥50mm and 6/15 (40%) complex. 13/25 patients (52%) underwent surgery for failure of cyst regression (11/13) or concern for interval torsion (2/13). Postnatal torsion occurred in 1/25 observation patients (4%), or 1/8 (13%) with cysts≥50mm. Overall rate of ovarian preservation between groups was not statistically different [6/8 (75%) observed versus 8/9 (89%) primary surgery; P=0.577]. Pathology found viable ovarian tissue in all oophorectomy specimens (N=3). CONCLUSIONS Postnatal torsion is rare. A period of observation spares half of neonates from an operation, without decreasing ovarian salvage. Initial management should consist of observation, regardless of size or complex characteristics. If operative intervention is necessary, ovary preserving techniques should be utilized.
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Assisted laparoscopic excision of huge abdominal cysts in newborns and infants using the umbilical laparoscopic port incision. J Pediatr Surg 2011; 46:1459-63. [PMID: 21763855 DOI: 10.1016/j.jpedsurg.2011.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 02/08/2011] [Accepted: 03/08/2011] [Indexed: 11/23/2022]
Abstract
PURPOSE The objective of this article was to present our experience in successfully managing a variety of abdominal cysts in newborns and infants using a mini-invasive technique performed in 8 cases using an umbilical laparoscopic port incision. METHODS Assisted laparoscopic excision using an umbilical port incision was performed in 8 cases. Six were neonates (5 ovarian cysts and one hepatic cyst) and 2 were infants (6-months old with intestinal duplication and 11-months old with lymphatic malformation). RESULTS The procedure was performed with ease and was successful in all 8 cases. Oral feeding was started early after the surgical intervention. Seven patients were discharged the next day. The last case was discharged on the fifth day after surgery because of intestinal resection. CONCLUSION This proposed mini-invasive technique using the umbilical port incision proved to be less invasive, easier, and less technically demanding than the classic laparoscopic approach and, hence, may be applied to different abdominal cystic pathologies in newborns and infants.
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Soccorso G, Walker J. A giant ovarian cyst in a neonate. J Pediatr Adolesc Gynecol 2009; 22:e17-20. [PMID: 19539190 DOI: 10.1016/j.jpag.2007.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Revised: 09/09/2007] [Accepted: 09/11/2007] [Indexed: 11/16/2022]
Abstract
BACKGROUND Antenatally diagnosed abdominal cysts are common, and frequently are ovarian in origin, which usually regress spontaneously. Surgery is indicated in the infantile period in case of very large, persisting or symptomatic cysts. Many surgeons feel that watchful waiting can be justified in newborns with simple and complex cysts. CASE We present a neonate with an ovarian cyst diagnosed antenatally by ultrasound (US) and showing persistent enlargement within 3 months after birth when reached a diameter of 13 cm. Assessment and treatment is described. CONCLUSION The extremely large, non-resolving ovarian cysts in neonates present a major challenge for clinicians and should be treated by surgery to avoid complications. We advocate laparotomy and cystectomy when possible to avoid unnecessary loss of functional ovarian tissue.
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Abstract
The etiology of ovarian cysts varies with the developmental stage and hormonal milieu of the patient. In general, most ovarian cysts are functional in nature and usually resolve without treatment. Treatment is indicated if the diagnosis is in question, the cyst persists, or the patient is symptomatic. Laparoscopy has become the approach favored by most pediatric surgeons for the treatment of ovarian cysts. All surgical procedures for ovarian cysts should spare functional ovary as much as is technically possible. Simple cysts should be fenestrated. Complex or functional cysts should be excised, with preservation of the remaining ovary.
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Affiliation(s)
- Mary L Brandt
- Division of Pediatric surgery, Michael E. DeBakey Deparment of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA.
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Abstract
UNLABELLED Foetal and neonatal ovarian cysts have previously been considered uncommon. With the development of sonography, however, the detection of cysts has increased. As ovarian cyst formation in the perinatal period is a self-limiting process, treatment options depend on the risk of complications and on the ability to differentiate these benign cysts from other pathology. The history of two neonates with an ovarian cyst detected antenatally with ultrasound techniques is described. CONCLUSION It is important that paediatricians have knowledge about the incidence, treatment and prognosis of foetal neonatal ovarian cysts.
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Affiliation(s)
- M F Vogtländer
- Department of Paediatrics, Groene Hart Hospital, Gouda, The Netherlands
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Ferro F, Iacobelli BD, Zaccara A, Spagnoli A, Trucchi A, Bagolan P. Exteriorization-aspiration minilaparotomy for treatment of neonatal ovarian cysts. J Pediatr Adolesc Gynecol 2002; 15:205-7. [PMID: 12459225 DOI: 10.1016/s1083-3188(02)00156-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Recent literature indicates that laparoscopic techniques are considered the most appropriate approach for management of neonatal ovarian cysts (NOC). However, laparoscopic equipment may be unavailable in most centers, has high costs, and demands a long learning curve, especially in newborns. METHODS A minilaparotomy with exteriorization-aspiration ("catch and suck") approach was used in 14 female newborns with antenatally diagnosed ovarian cysts. Average operating time was 25 minutes (range 15-45 min.). Postoperative course was uneventful in all cases; no intra- or postoperative complications were recorded. Length of stay was 48 hours in all patients. CONCLUSIONS Minilaparotomy with cyst aspiration and subsequent removal may prove a reliable and safe technique in the treatment of NOC: operating time and length of stay are not significantly longer than laparoscopic approach, making this procedure a valid alternative.
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Affiliation(s)
- F Ferro
- Department of Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
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Davies BW. An elegant method of reducing surgical trauma when dealing with a large simple neonatal ovarian cyst. J Pediatr Surg 2002; 37:143. [PMID: 11782009 DOI: 10.1053/jpsu.2002.29464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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