title: Management of pediatric and adolescent adnexal masses by gasless laparoendoscopic single-site surgery.
abstract: OBJECTIVE
  To evaluate the safety and feasibility of gasless transumbilical laparoendoscopic single-site (LESS) surgery for the management of adnexal masses in pediatric and adolescent girls aged 19 years or younger.
  
  
  METHODS
  Retrospective study of 28 pediatric and adolescent girls each undergoing gasless LESS surgery and gasless multiport laparoscopic surgery for adnexal masses. In each case, laparoscopic surgery was performed by the abdominal-wall lift method under endotracheal general anesthesia. The two groups were compared for their patient demographics and surgical outcome measures.
  
  
  RESULTS
  In the LESS surgery group, median age of the patients including three pre-menarcheal girls was 17.5 years. The most common symptom was abdominal pain. Median tumor diameter in the LESS surgery group was 7.4cm. There were no statistical differences in clinical features between LESS surgery and multiport laparoscopic surgery groups. In the LESS surgery group, adnexal masses were managed by unilateral cystectomy (n=20), unilateral salpingo-oophorectomy (n=5), bilateral cystectomy (n=2), and unilateral salpingectomy (n=1). Emergency LESS surgery was performed for seven cases due to adnexal torsion and one case due to cyst rupture. Preservation of affected ovary was not achieved in three emergency cases with adnexal torsion due to severe necrosis, and in one case each of recurrent mucinous cystadenoma and huge mucinous cystadenoma. In 24 adnexal masses from 22 girls who received adnexal cystectomy by LESS surgery, LESS-assisted extracorporeal cystectomy, was possible in 14 masses while intracorporeal cystectomy was required in other 10. In a case of dermoid cyst managed by LESS-assisted extracorporeal cystectomy, additional hemostasis was required by intracorporeal suturing due to laceration of utero-ovarian ligament. Median-excised tissue weight in the LESS surgery group was 111g. Significant differences between LESS surgery and multiport laparoscopic surgery groups were not noted in surgical outcomes and pathological diagnosis, except for significantly lower C-reactive protein value on postoperative day 3 in the LESS surgery group.
  
  
  CONCLUSIONS
  Gasless LESS surgery for pediatric and adolescent adnexal masses is a safe and feasible alternative to multiport laparoscopic surgery.
authors.affiliation: Department of Obstetrics & Gynecology, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-cho, Tajimi, Gifu 507-8522, Japan. Electronic address: gyendoscopy@gmail.com.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Takeda
authors.affiliation: Department of Obstetrics & Gynecology, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-cho, Tajimi, Gifu 507-8522, Japan.
authors.forename: Sanae
authors.initials: S
authors.lastname: Imoto
authors.affiliation: Department of Obstetrics & Gynecology, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-cho, Tajimi, Gifu 507-8522, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Nakamura
mesh_terms: D000291:Adnexal Diseases / Q000601:surgery*; D000293:Adolescent; D002648:Child; D018291:Cystadenoma, Mucinous / Q000601:surgery*; D003884:Dermoid Cyst / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D010051:Ovarian Neoplasms / Q000601:surgery*; D010052:Ovariectomy; D012189:Retrospective Studies; D058994:Salpingectomy; D013724:Teratoma / Q000601:surgery*; D014102:Torsion Abnormality / Q000601:surgery; D055815:Young Adult
keywords: Adnexal mass; Adolescent girl; Gasless laparoscopic surgery; Laparoendoscopic single-site surgery; Pediatric girl; Surgical outcome