Access to Conservative Surgical Therapy for Adolescents With Benign Ovarian Masses

Abstract

II.

Laparoscopic Suturing as a Barrier to Broader Adoption of Laparoscopic Surgery

“…For example, although for the treatment of gynecological diseases laparoscopic surgery is generally considered equivalent or superior to laparotomy, less than 60% of benign ovarian masses in adolescents are treated with laparoscopy 30 and fewer than 15% of hysterectomies are performed by this method. 31–33 …”

Management of Adnexal Masses in Children and Adolescent Populations: Advocating for Ovarian Conservation

“…2,3,7,11 Current literature indicates a significant trend over recent decades to- Berger-Chen and colleagues assessed the Perspective database and showed that since 2000, use of laparoscopy has increased from 32.1 to 57.9%, although these rates are affected by socioeconomic factors such as African-American race (OR 0.49) and geographic location in the Northeastern United States (OR 0.65). 3 Patients undergoing laparoscopy are 2 times more likely to have cystectomy performed. 3 Presence of a Gynecologist as primary surgeon increases use of laparoscopy and ovarian conserving surgery, as much as 8.7 times for all masses and 15 times for benign masses.…”

“…3 Patients undergoing laparoscopy are 2 times more likely to have cystectomy performed. 3 Presence of a Gynecologist as primary surgeon increases use of laparoscopy and ovarian conserving surgery, as much as 8.7 times for all masses and 15 times for benign masses. 12 Gynecologists are more often involved when the patient is post-menarchal or greater than 15 years of age.…”

“…Historically, surgical management recommendations were for laparotomy with unilateral salpingo-oophorectomy, in an effort to avoid incomplete excision of cancer. [1][2][3] Laparoscopy has since replaced laparotomy as the surgical method of choice, however ovarian conservation procedures are often not considered unless a gynecologist is present. This goal of this article is to address the importance of ovarian conservation in adnexal masses in children and adolescents.…”

“…2,4,5 The majority of these cases are benign, as malignancy rates have been quoted between 3.7 and 23.5%, 2 however ovarian cystectomy is still only performed in 61.4% of cases. 3 The differential diagnosis of adnexal masses lists both benign and malignant tumors (Table 1). Benign masses include cysts, endometriomas ("chocolate cysts"), mature cystic teratomas (dermoids), cystadenomas (serous or mucinous), ectopic pregnancy, or other benign neoplasms.…”