title: A new surgical approach of temporary ovarian transposition for children undergoing brachytherapy: technical assessment and dose evaluation.
abstract: OBJECTIVE
  We developed a new technique of temporary ovarian transposition (OT) for prepubertal girls undergoing brachytherapy. The aim of this study was to describe it, assess its feasibility and safety and calculate the dose delivered to the ovary in order to prove its efficacy.
  
  
  METHODS
  Sixteen prepubertal patients underwent temporary OT for brachytherapy at our center from March 2001 to December 2012. OT was done either by laparotomy or by laparoscopy. In all patients, the ovaries were grasped with an atraumatic forceps and mobilized above the iliac crest level as high as possible without any dissection or division of the ovarian ligaments or of the fallopian tube. They were sutured to the anterior abdominal wall by a transfixing stitch of non-dissolvable suture knotted on the outside of the patient on a pledget.
  
  
  RESULTS
  Median age at surgery was 3 years (range: 2-9 years). The integrity of the fallopian tube was respected and not a single ligament was dissected or divided. None of the patients had intraoperative or postoperative complications. The stitches were retrieved after completion of irradiation and the ovaries in all the patients fell back into the pelvis. The calculated median radiation dose to the ovary was 1.4 Gy (range: 0.4-2.4 Gy).
  
  
  CONCLUSIONS
  This surgical technique is simple and safe, either by laparotomy or by laparoscopy. It meets the radiation and physical constraints in prepubertal girls with vaginal or bladder RMS. However, longer follow-up is required to assess the ovarian function.
authors: Department of Pediatric Surgery, Bicêtre Hospital, Hôpitaux Universitaires Paris Sud, AP-HP, France. Electronic address: guenolee.delambert@bct.aphp.fr.
authors: Guénolée
authors: G
authors: de Lambert
authors: Department of Radiotherapy, Institut Gustave Roussy, France.
authors: Christine
authors: C
authors: Haie-Meder
authors: Department of Pediatric Surgery, Bicêtre Hospital, Hôpitaux Universitaires Paris Sud, AP-HP, France.
authors: Florent
authors: F
authors: Guérin
authors: Department of Pediatric Surgery, Bicêtre Hospital, Hôpitaux Universitaires Paris Sud, AP-HP, France.
authors: Julia
authors: J
authors: Boubnova
authors: Department of Pediatric Surgery, Bicêtre Hospital, Hôpitaux Universitaires Paris Sud, AP-HP, France.
authors: Hélène
authors: H
authors: Martelli
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000532:radiotherapy; D001918:Brachytherapy; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D010053:Ovary / Q000502:physiology / Q000528:radiation effects* / Q000601:surgery*; D011879:Radiotherapy Dosage; D012208:Rhabdomyosarcoma / Q000532:radiotherapy; D001749:Urinary Bladder Neoplasms / Q000532:radiotherapy*; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*; D014625:Vaginal Neoplasms / Q000532:radiotherapy*
keywords: Brachytherapy; Prepubertal girls; Temporary laparoscopic ovarian transposition