Laparoscopic removal of autoamputated adnexa in infants and neonates

Abstract

Objective The aim of this study was to describe a new case of autoamputated adnexa in a neonate treated with laparoscopy and to present a review of the  literature as regards laparoscopic management of the autoamputated adnexa in neonates and infants.
Summary background data Laparoscopic surgery has become an accepted modality internationally in neonates and infants. We analyzed technical details of laparoscopic procedures adopted in the literature for this rare condition.
Materials and methods A literature review was performed to identify additional cases of autoamputated adnexa treated laparoscopically. Cases were limited to the English language and to those affecting girls under 1 year of age.
Results In addition to our presented case, 12 cases of autoamputated adnexa in patients less than 1 year of age treated laparoscopically were identified in the literature. Surgical intervention was planned for increasing size of cysts, for no signs of reduction, or for complex cysts, except in one case for suspicion of enteric  duplication. The number of ports for the removal varies from one to three based on different authors. The operative port size ranged from 3 to 5 mm. Camera size was 5mm for all authors when reported but only five authors reported the size of the umbilical port.
Conclusion Although laparoscopic removal of autoamputated adnexa can be  successfully accomplished in newborns and infants, 50% of autoamputated adnexa are still treated with laparotomy. Our review revealed the necessity of at least two ports for the identification and removal of the adnexa using the laparoscopic-assisted technique, whereas three trocars in the presence of tenacious adhesions.

Keywords: adnexal torsion, autoamputated adnexa, laparoscopy, technique