Ovarian Cyst Aspiration in the Neonate: Minimally Invasive Surgery

doi:10.1016/j.jpag.2014.10.003

Journal of Pediatric and Adolescent Gynecology

Volume 28, Issue 5, October 2015, Pages 348-353

https://doi.org/10.1016/j.jpag.2014.10.003 Get rights and content

Abstract

Study Objective

To review our experience with laparoscopic aspirations and minimally invasive surgeries for neonatal ovarian cysts and report the outcome of their follow-up.

Design

Twenty-one neonates diagnosed as having ovarian cysts were retrospectively reviewed at our hospital from 2006 through 2013.

Results

Of 21 neonates, 8 showed simple cysts and 13 showed complex cysts in their ultrasound scan. Laparoscopic aspiration was performed for all neonates with simple cysts. Torsion was found in 7 of 13 neonates with complex cysts. Three neonates underwent detorsion, while 2 neonates underwent oophorectomy. Two neonates already showed autoligation, showing a cystic mass, which was removed. The remaining 6 neonates with a complex cyst underwent only aspiration because no torsion was found. Of 14 neonates who underwent only aspiration, 11 showed no cyst, while 3 neonates, having a cyst with a size of less than 2 cm, underwent follow-up. Of 3 neonates who underwent detorsion, 1 showed an ovary without cyst, while 2 showed neither cyst nor ovary.

Conclusion

Laparoscopically, neonatal ovarian cysts may be diagnosed and aspirated simultaneously, simply, and safely.

Introduction

Ovarian cysts (OCs) are the most frequent prenatally diagnosed intra-abdominal cysts. The etiology of fetal OCs is still unknown. Among various hypotheses that persevere, the most widely accepted one may be the suggestion that the fetal ovary generates cysts under the influence of various hormones, such as fetal gonadotrophins, maternal estrogen, and placental human chorionic gonadotrophin.1, 2, 3, 4 Most fetal OCs are small and involute within the first few months of life, and they are of no clinical significance. Nevertheless, OCs that become large may cause the ovary to move out of its usual position in the pelvis, increasing the chance of painful twisting of the ovary—an ovarian torsion, which leads to a consequent loss of the ovary. Thus, the management of OC entails taking preventative measures against a potential ovarian torsion.

Treatment modality of OCs is controversial. In recent years, various case studies of prenatal and postnatal treatment of OCs were published.5, 6, 7, 8, 9, 10 There are numerous reports on the use of ultrasound (US)-guided aspiration or laparoscopic oophorectomy for the treatment of OCs. In this study, laparoscopic aspiration, detorsion, unroofing, or oophorectomy was performed for the neonatal OCs. The authors reported on these cases along with the outcome of their follow-up.

Section snippets

Materials and Methods

This retrospective study analyzed, with the use of patient charts, 21 patients who had been diagnosed as having OC and had undergone laparoscopic surgery at the Asan Medical Center Children's Hospital, University of Ulsan School of Medicine, from April 2006 through March 2013. The study protocol was approved by the Asan Medical Center Institutional Review Board.

In all cases, the US diagnosis was made during routine pregnancy examinations between 28 and 37 weeks of gestation. Each case was

Results

The average birth weight of these subjects was 3322.3 ± 387.8 g, and the mean gestational age at birth was 38.4 ± 1.1 weeks. The mean diameter of these cysts in the first US finding after birth was 5.1 ± 1.4 cm. The clinical features of these neonates are shown in Table 1, Table 2.

Discussion

Recently, prenatal detection of OCs has been common (34%) with the increasing use of real-time US.⁴ In the majority of OC cases, the natural course of the disease is spontaneous resolution either prenatally or postnatally.11, 12, 13 However, various complications are associated with OCs. These complications include compression on other viscera, rupture of the cyst, hemorrhage, and ovarian torsion with a consequent loss of the ovary—the most common one. Ovarian torsion may also result in

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Cited by (17)

Approaches to the management of pediatric ovarian masses in the 21st century: Systematic review and meta-analysis
2020, Journal of Pediatric Surgery
Citation Excerpt :
Unlike in adults, mucinous adenocarcinoma was the most common histological subtype encountered in the pediatric age group. [18,19,23,28] Twenty-four studies (N = 713) assessed only laparoscopic surgical management of pediatric ovarian masses [11,12,33–53,58]. Most of the studies were conducted in high-income countries, while five studies were conducted in upper middle-income countries, and one was conducted in India, a lower-middle-income country. (
Laparoscopy is increasingly being adopted for the treatment of ovarian pathologies in adults. However, its implementation for the management of pediatric ovarian masses varies and the evidence, to date, has not been comprehensively analyzed. This review aims to compare laparoscopic and open surgical management of pediatric ovarian masses.
We searched PubMed, Cochrane Library and Google Scholar from the year 2000 till April 2017. Studies selected for this included those on epidemiological trends of pediatric ovarian lesions, assessing outcomes of laparoscopic management and comparison of laparoscopic and open surgical techniques for pediatric ovarian masses. A meta-analysis comparing outcomes of both modalities was performed using standard methodology.
A total of 44 studies met the inclusion criteria of which 15 were on histological types of ovarian lesions, 24 assessed laparoscopic management only and five compared laparoscopy with open surgery for pediatric ovarian masses. Nonneoplastic lesions were the most common ranging from 36.5% to 73.7%, with cystic lesions being the most prevalent.
Neoplastic lesions ranged between 26.3% and 63.5%, with germ cell tumors being the most common, while malignancy ranged between 3.5% and 10.8%. Laparoscopic management was generally advocated for managing benign lesions with a cautious approach for suspicion of malignant lesions. In comparison to open surgery, laparoscopic surgery had shorter operating time (MD = − 33.24 min, 95% CI = − 34.29 to − 32.19, p < 0.0001), less intraop bleeding (MD = − 61.46 ml, 95% CI = − 62.69 to − 60.24, p < 0.0001), and reduced length of hospital stay (MD = − 2.78 days, 95% CI = − 2.82 to − 2.74, p < 0.0001). Complication rates were equivocal between the two approaches. Spillage rates could not be assessed.
Limited evidence suggests that laparoscopic approach to presumptively benign ovarian masses have better outcomes when compared to open surgery with regards to operating time, blood loss and hospital stay. However, complication rates were similar between the two approaches. Studies with rigorous scientific methods are needed for a definitive recommendation, especially in resource limiting settings. However malignant lesions should still be managed with an open surgical approach to avoid upstaging of disease status.
II.
Management of ovarian lesions diagnosed during infancy
2019, Journal of Pediatric Surgery
Citation Excerpt :
Whether these cysts would have resolved on their own with simple observation has not been prospectively studied, but aspiration remains a reasonable alternative in the management of larger fluid-containing simple cysts. Aspiration also prioritizes ovarian preservation by reducing the risk of torsion and preserving ovarian tissue [31,32]. The majority of patients who were managed operatively had ovaries that were noted to be autoamputated, but six patients still had their ovaries removed.
Prior studies of infant ovarian cysts have recommended intervention for those larger than 4 cm. We reviewed the natural history and features of those managed operatively versus nonoperatively.
A retrospective study was performed of ovarian lesions in children < 1 year-old from 2000 to 2014.
Forty patients were identified. Twenty-eight (70%) underwent operative management, while 12 (30%) were managed conservatively, including one undergoing aspiration. The mean age at surgery was 125 days. All but one patient (96%) had evidence of antenatal torsion intraoperatively or on final pathology. All resected lesions were benign. Ultrasound findings more common in those undergoing surgery included intracystic debris (p < 0.001), fluid–fluid or fluid–debris levels (p = 0.002), absence of Doppler flow (p = 0.014), solid components (p = 0.04), and calcifications (p = 0.001). Cysts managed nonoperatively had an average diameter of 2.5 cm, compared to 5.1 cm in the operative group (p < 0.001). Three of the lesions managed nonoperatively had a diameter greater than 3.5 cm (mean 5.1 cm) and were followed for an average of 153 days until resolution.
The majority of infant ovarian lesions were excised, although none were malignant. Aspiration or observation of larger cysts was feasible and safe. Ovarian cysts in this age group should be considered for nonoperative management and closely followed.
IIC.
Diagnostic Imaging: Pediatrics
2017, Diagnostic Imaging: Pediatrics
Fetal Ovarian Cyst—A Scoping Review of the Data from the Last 10 Years
2023, Medicina (Lithuania)
European Paediatric Surgeons' Association Consensus Statement on the Management of Neonatal Ovarian Simple Cysts
2023, European Journal of Pediatric Surgery
Fertility preservation and preoperative evaluations of ovarian torsion in children and adolescents
2022, Chinese Journal of Pediatric Surgery

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: The authors indicate no conflicts of interest.

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Original StudyOvarian Cyst Aspiration in the Neonate: Minimally Invasive Surgery

Abstract

Study Objective

Design

Results

Conclusion

Introduction

Section snippets

Materials and Methods

Results

Discussion

J Pediatr Surg

Am J Obstet Gynecol

J Pediatr Surg

J Pediatr Surg

J Pediatr Surg

Int J Gynaecol Obstet

Semin Pediatr Surg

Semin Pediatr Surg

J Pediatr Surg

J Pediatr Surg

Neonatal ovarian cysts: pathogenesis, diagnosis and management

Pediatr Radiol

Spontaneous resolution of neonatal ovarian cysts

AJR Am J Roentgenol

Fetal and neonatal ovarian cysts: is surgery indicated?

Prenat Diagn

Foetal and neonatal ovarian cysts: a 5-year experience

Arch Gynecol Obstet

Original Study
Ovarian Cyst Aspiration in the Neonate: Minimally Invasive Surgery