Laparoscopic-Assisted Transumbilical Extracorporeal Ovarian Cystectomy (LATEC): As an Alternation to the Open Surgical Approach in the Management of Neonatal Ovarian Cysts

Introduction: Congenital ovarian cysts are a well-known problem affecting up to 34% of newborn females. The widespread use on antenatal ultrasonography has increased the frequency of detection of this problem. Generally in case of simple cysts more than 4-5cm in diameter and in complex cysts, surgical removal of the mass is most often recommended in the clinical, surgical, and radiologic literature in an attempt to preserve viable ovarian tissue. Laparoscopic-assisted transumbilical extracorporeal cystectomy LATEC technique was published in 2008. LATEC involved transumbilical laparoscopy, percutaneous cyst aspiration, and then cyst evisceration through the umbilicus. Laparoscopic cyst decapsulation or cyst wall removal gives a valuable option for ovarian preservation.The aim of this study was to evaluate LATEC as an alternation to the open surgical approach in cases when cystectomy or salpingo-oophorectomy is decided and to evaluate laparoscopic decapsulation - as an organ salvage procedure - when viable ovarian tissue is thought to be present even if there is no ultrasonographic evidence. Material and Methods: During the period from March 2009 till March 2010, seven female neonates were referred to the pediatric surgery service. All patients were suspected antenatally by using fetal ultrasonography to have intraabdominal cysts most likely to be ovarian in origin. Conservative management was tried in all patients and only one patient showed regression in size. Surgery was decided for the remaining six. LATEC was done to four patients and decapsulation of the cysts were done to the remaining two patients. Follow-up of all patients continued for one year in the form of monthly ultrasonography. Discussion: In this study LATEC was done in four patients (n=4) and all cysts were removed easily after minimal stretching of the umbilical incision. Laparoscopic decapsulation was used in two cases with bilateral simple cysts. They showed no formation of new cysts and preservation of ovarian integrity bilaterally in six months time post surgery. The ultrasonography showed evidence of viable ovarian tissues bilaterally in both cases with detectable signals on Doppler ultrasonography. Conclusion: Laparoscopic-assisted transumbilical extracorporeal cystectomy LATEC is a valid alternation to the open surgery in cases when cystectomy or salpingo-oophorectomyis decided. Laparoscopic decapsulation of the ovarian cysts is technically straightforward and promising procedure and gives better chance for salvage of the affected ovary while simultaneously yielding tissue for histopathological examination.