Impact of laparoscopy for diagnosis and treatment in patients with disorders of sex development.
OBJECTIVE
To review laparoscopy in patients with disorders of sex development (DSD) in order to clarify its usefulness in diagnosis, devising subsequent therapeutic strategies and managing patients with various conditions.


METHODS
Between April 1992 and December 2012, 29 laparoscopic surgeries were performed in 25 DSD patients. Among them, ten were diagnostic laparoscopy including gonadal biopsy, and 19 were therapeutic laparoscopy. Surgical procedures and complications were evaluated.


RESULTS
For diagnostic laparoscopy, laparoscopic gonadal biopsy was performed in three patients. Inspection, with or without open gonadal biopsy, was performed on four out of seven patients with 46XY DSD or mixed gonadal dysgenesis (MGD). Additional surgery was planned and performed based on diagnostic laparoscopic findings in six out of seven patients. In the three patients with ovotesticular DSD, the gonadal pathology was diagnosed as: testis/ovary in one, testis/ovotestis in one and ovary/ovotestis in one--this was from the laparoscopic inspection and/or gonadal biopsy. However, the final diagnoses were bilateral ovotestis in two patients and ovary/ovotestis in one patient. For therapeutic laparoscopy, surgical procedures were: gonadectomy in 17 patients (bilateral in 13, unilateral in three, partial in two); hysterectomy in two patients; orchiopexy in one; and sigmoid vaginoplasty in one patient (included multiple procedures). There were no severe perioperative complications. In the four patients with a history of diagnostic laparoscopy, no severe intra-abdominal adhesions that would disturb therapeutic laparoscopic surgery were observed.


CONCLUSIONS
While diagnostic laparoscopy was helpful in devising a therapeutic surgical strategy in most of the patients with DSD who were suspected as having complex gonadal status or Müllerian duct derivatives, attention must be paid to precisely diagnosing the gonadal status in ovotesticular DSD. On the other hand, therapeutic laparoscopic surgeries were valuable procedures in treating DSD patients, even with a history of previous diagnostic laparoscopy.
Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo 060-0824, Japan. Electronic address: k-moriya@med.hokudai.ac.jp.
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Moriya
Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo 060-0824, Japan. Electronic address: kenordic@mac.com.
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Morita
Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo 060-0824, Japan. Electronic address: mitsui68@med.hokudai.ac.jp.
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Mitsui
Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo 060-0824, Japan. Electronic address: kitta@fb3.so-net.ne.jp.
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Kitta
Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo 060-0824, Japan. Electronic address: tamago929@yahoo.co.jp.
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Nakamura
Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo 060-0824, Japan. Electronic address: k-masafumi@mri.biglobe.ne.jp.
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Kon
Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo 060-0824, Japan. Electronic address: k-nonno@med.hokudai.ac.jp.
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Nonomura
D000293:Adolescent; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D012734:Disorders of Sex Development / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006066:Gonads / Q000473:pathology; D006801:Humans; D007044:Hysterectomy; D007223:Infant; D010535:Laparoscopy; D008297:Male; D056126:Orchiopexy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery; D055815:Young Adult
Diagnosis; Disorders of sex development; Laparoscopy; Treatment