Robotic assisted ovary preserving excision of a benign serous cystadenoma in a prepubertal symptomatic girl
Epublication WebSurg.com, Dec 2019;19(12). URL: http://websurg.com/doi/vd01en5737
Symptomatic ovarian cysts or larger incidentally diagnosed ovarian cysts require treatment. If features of malignancy can be reasonably ruled out, minimally invasive procedures can be offered to not only excise the lesion but also preserve the ovary at the same time. A 10-year-old female child was referred to our department with complaints of right lower abdominal pain which lasted for 6 months. She had no history of vomiting. On examination, her abdomen was soft, non-tender, with no palpable mass, and not distended. Abdominal sonography revealed a 5 by 4.5cm simple cyst in the right adnexa with a 1.7mm wall thickness, with no solid component or septation. Her right ovary was not seen separately. Her left ovary and uterus showed no abnormalities. Malignancy work-up revealed nothing suspicious (Beta-HCG: 2.9 IU/L, AFP: 1.3ng/mL, CA125: 10.9, all within normal range). A robotic-assisted complete cyst excision with preservation of the ovary was performed using 3 arms of the Da Vinci Xi™ robotic surgical system. The patient resumed oral food intake the same evening. He was discharged the following day within 24 hours of the procedure on paracetamol only. The patient was healthy and well. The biopsy reported a benign serous cystadenoma. At a 1-year follow-up, the child is asymptomatic and ovarian preservation was confirmed on postoperative ultrasound. While oophorectomy is eminently feasible with a minimally invasive approach, ovary preservation in benign lesions is quite challenging using pure laparoscopy. Robotic assistance, with its 3D binocular high-definition vision, articulating instruments, and availability of simultaneous energy in both arms, provides better precision and a maximum range of movements. It also helps to preserve the ovary while removing the cyst completely. The case report with a stepwise video of the procedure is demonstrated.