The laparoscopic management of intersex patients: the preferred approach.
In the world's largest series of patients with intersex treated by laparoscopy, authors from Sao Paulo found that this technique allowed easy identification and removal of gonads. They also found that other organs could be removed and genitoplasty performed.


OBJECTIVE
To present possibly the largest series of the use of laparoscopy for treating intersex patients.


METHODS
Fifty intersex patients (34 with male and two with female pseudohermaphroditism, nine with gonadal dysgenesis, four with true hermaphroditism, and one with complex hypospadias), aged 0.5-46 years (mean 18.3), underwent laparoscopy to remove gonads and/or ductal structures incompatible with the social gender, or for gonadal tumour or a potential risk for malignancy. When necessary, genitoplasty was performed concomitantly.


RESULTS
At the laparoscopic evaluation, 10 gonads of six patients were absent, while four were identified as 'vanishing'; 72 gonads (46 dysgenetic, 17 normal testes, one normal ovary, one ovotestis, seven gonadoblastomas or dysgerminomas) were removed; two ovotestes were replaced in the scrotum after removing the ovarian segment, as was one normal testis. Twelve patients with a urogenital sinus had its vaginal component removed, 11 including a hysterectomy. Three of these patients had a combined perineal approach to complete its removal, together with masculinizing genitoplasty. There were no intraoperative complications or conversions; two patients had complications after surgery.


CONCLUSIONS
Laparoscopy allows the straightforward identification and removal of gonads. All abnormal ductal structures must be removed, as this increases the chance of resecting unidentified gonads. Removing the uterus and vaginal component of the urogenital sinus in patients with male social sex is feasible, with low morbidity. Genitoplasty, according to the social sex, can be performed in the same procedure.
Dénes
Francisco T
FT
Division of Urology, University of Sao Paulo School of Medicine Hospital, Sao Paulo, Brazil.
Cocuzza
Marcelo A S
MA
Schneider-Monteiro
Edison D
ED
Silva
Frederico A Q
FA
Costa
Elaine M F
EM
Mendonca
Berenice B
BB
Arap
Sami
S
D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical; D002648:Child; D002675:Child, Preschool; D012734:Disorders of Sex Development / Q000601:surgery*; D005260:Female; D006059:Gonadal Dysgenesis / Q000601:surgery*; D006066:Gonads / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged