Review of laparoscopic median sacral artery ligation in sacrococcygeal teratoma

Abstract

Introduction Sacrococcygeal teratoma is one of the commonest neonatal tumour usually presenting as a large exophytic sacral mass in utero and at birth. It is a highly vascular tumour and the main blood vessel supplying it is median sacral artery (MSA) which can cause torrential haemorrhage during excision. Many surgeons advocate ligation of MSA prior to tumour excision. Traditionally it was done by laparotomy or by posterior midline approach prior to tumour excision. Methods Laparoscopic ligation of MSA in neonates prior to tumour excision was performed using a ultrasonic dissector to expose the area. Using endoclips the artery was ligated, following which the tumors were resected. Results The procedures were completed with minimal blood loss and successul excision of the tumor was achieved in our patients. Conclusion Haemorrhage is the principal concern during sacrococcygeal teratoma excision. This risk can be safely minimized by laparoscopically ligating the median sacral artery which is the principal feeding vessel for the tumor.

Giant malignant sacrococcygeal germ cell tumor in a newborn: A rare case report

“…Cross-sectional imaging studies such as CT and MRI play a central role in the management of SCT because, in addition to providing invaluable information that helps determine the diagnosis, define the type of mass by delineating its extension and relationship with the adjacent anatomical structures, so as to develop an appropriate surgical plan that enables complete resection of the neoplasm including coccygectomy [2 , 6 , [12] , [13] , [14] , [15] . CT and MRI are also very important in the evaluation of giant (>10 cm) hypervascular SCT, which is associated with a high risk of rupture and consequently severe bleeding during the operation unless the tumor is devascularized by ligation of the median sacral artery, which is considered its principal feeding vessel [5 , [7] , [8] , [16] , [17] . As in our case, the MRI is primarily used for evaluation of intraspinal invasion and for excluding the meningocele and myelomeningocele which are birth defects, grouped together under the term spina bifida cystica, looking like a sac filled with fluid leading out from the newborn's spine.…”

Pediatría General Tomo 7

“…Debido a que el TSC es altamente vascularizado se deberá prevenir el sangrado ligando la arteria sacra media, y esto puede realizarse usando embolización preoperatoria, o ligando la artería por abordaje laparoscópico o por laparotomía abierta 36,37,38,39 Después de insertar un catéter urinario, el paciente se coloca en la posición decubito prono con un realce bajo la sínfisis del pubis 40 . Es de suma importancia identificar el curso del canal anal y el recto, esto se puede realizar empleando manipulación digital durante el procedimiento quirúrgico, o introduciendo gasa impregnada de vaselina, parafina o yodo-povidona en el recto, o colocando un dilatador de Hegard, de esta manera se evita lesionar el recto durante la disección del TSC 40 .…”

Management strategy and outcomes of sacrococcygeal teratoma — an Egyptian multicenter experience

“…Interdisciplinary management can achieve an overall survival of up to 80% [ 1 , 9 , 10 ]. Operative complications include hemorrhage due to injury of median sacral artery [ 11 ] and tumor rupture with subsequent recurrence [ 12 ]. Additionally, functional problems related to urological and bowel control [ 13 ] and unsatisfactory scars may be encountered during long-term follow-up [ 14 ].…”