LAPAROSCOPIC APPROACH TO OVARIAN PATHOLOGY IN CHILDREN AND ADOLESCENTS

Laparoscopic procedures are constantly finding wider application in ge neral and pediatric surgery. The female child and adolescent presentin g with suspected acute or chronic ovarian pathology may be an ideal ca ndidate for laparoscopic surgery. From March 1992 to December 1993, si x girls aged 7 to 18 years underwent seven laparoscopic operations for ovarian pathology at Childrens Hospital Los Angeles. Clinical present ations included virilization with primary amenorrhea (1), precocious p uberty (1), malignant dysgerminoma (second look) (1), and abdominal pa in (3). Postoperative diagnoses were dysgerminoma (1), bilateral gonad oblastoma in a 46 XY chromosomal phenotypic female with dysgenetic gon ads (1), negative biopsy (1), serous cystadenoma with acute torsion (1 ), ovarian cyst (1), and ovarian torsion (1). Operations performed wer e unilateral salpingo-oophorectomy (1), unilateral salpingo-oophorecto my with contralateral biopsy (2), bilateral salpingo-oophorectomy (1), diagnostic biopsy (2), and ovarian cystectomy with oophoropexy (1). T here were no operative complications. One patient underwent two operat ions, a biopsy followed by unilateral salpingo-oophorectomy. Only one patient required a mini-laparotomy for delivering a large tumor mass. Mean operative time was 138 min, mean hospital stay 2.0 days. We encou ntered two malignant cases, which were definitively treated by laparos copic resection, These two patients remained free of disease 12 to 18 months later. The laparoscopic approach to ovarian pathology in childr en and adolescents is an effective method for diagnosis as well as def initive therapy. Our initial experience is presented followed by recom mendations for clinical practice.