Minimally invasive surgery for ovarian cysts in children: transumbilical versus laparoscopic approach

Abstract

Background/purpose A transumbilical approach was recently reported for management of several surgical procedures in children. The aim of this study was to evaluate the feasibility and safety of a minimally invasive transumbilical approach against the laparoscopic approach in the management of ovarian cysts in children.
Patients and methods This prospective study was conducted at Tanta University Hospital and at affiliated hospitals from April 2005 to May 2011. A total of 21 patients aged between 2 days and 8 years with ovarian cysts were included. Patients were randomly divided into two groups: group 1 (n= 11) underwent the transumbilical approach, whereas group 2 (n= 10) were treated by laparoscopy. Patients were evaluated with respect to operative time, need to convert to open surgery or to increase umbilical incision, any intraoperative and/or postoperative complication, total hospital stay, and final cosmetic outcome.
Results The ovarian cysts were simple, not complicated, and larger than 5cm in 12 patients. Mixed cystic and solid parts were present in three patients. In another six patients, the cysts were complicated by torsion (n=4) or by hemorrhage inside the cysts (n= 2). The mean size of the ovarian cysts was not statistically significant in either group (8.2 cm in group 1 vs. 7.8cm in group 2). The mean operative time was shorter in group 1 compared with that in group 2 (45 ±12 vs. 55 ±10 min). Extension of umbilical incision was needed in one patient in group 1 and in another two patients in group 2 (site of the umbilical port) for the extraction of ovarian cysts containing a solid tumor inside. Duration of hospital stay was comparable in both groups (1–2 days in both groups). No significant intraoperative or postoperative complications were recorded in both groups. Likewise, the cosmetic outcome was excellent in both groups.
Conclusion Both the transumbilical and laparoscopic
approaches are feasible and safe for treatment of ovarian cysts in children. The results of both approaches are comparable. The transumbilical approach seems to be an attractive alternative for managing ovarian cysts in children in the absence of appropriate settings for laparoscopy.

Keywords: children, laparoscopy, neonates, ovarian cyst, torsion, transumbilical approach