Ovarian Tissue Collection for Cryopreservation in Pediatric Age: Laparoscopic Technical Tips

A review of reported surgical techniques in fertility preservation for prepubertal and adolescent females facing a fertility threatening diagnosis or treatment

“…20,21 Unlike cortical tissue biopsies, the partial excision technique extracts a single block of cortical tissue from either one or both ovaries. 22,23 Anywhere from 1/4 to 2/3 of ovarian tissue is removed for cryopreservation purposes leaving a partially intact ovary in situ. 17,18,20,22,24,25 In many cases, the right ovary was selected due to its preferred anatomic location away from the sigmoid colon.…”

“…20,22,25 One report noted the use of a thrombin hemostatic matrix and another the use of argon beam coagulation to gain a more superficial level of hemostasis out of concern for cautery damaging to the remaining ovarian tissue. 21,23 Data in the adult gynecology literature suggests that both bipolar and ultrasonic electrocautery have effects on the reserve of remaining ovarian tissue after laparoscopic ovarian cystectomy. 27–29 Poirot et al modified their approach after observing thermal injury of their partial oophorectomy specimens and proceeded with unilateral oophorectomy for the remainder of the study.…”

“…18,20,22,24 One incident of clinically significant intraoperative blood loss requiring transfusion was described in a pediatric patient. 23 …”

“…All ovarian cortical tissue was harvested laparoscopically but the amount of tissue removed varied between authors. Borgstrom et al and Feign et al report removing 25-50% of ovarian cortical tissue from one ovary, 19,24 while Lima et al and Fabbri et al report bilateral partial oophorectomies 19,20,23,24 . One patient was reported to have significant intraoperative hemorrhage requiring transfusion, otherwise no significant complications were documented.…”

“…One patient was reported to have significant intraoperative hemorrhage requiring transfusion, otherwise no significant complications were documented. 23 The pediatric population is most at need for a defined OTC procedure, as they have no other pre-treatment options to preserve their fertility at this time.…”