Background: Sacrococcygeal teratomas (SCT) are classically approached posteriorly through an inverted chevron incision. In large, external, mainly solid SCT, prior interruption of the arterial supply is warranted because of impending heart failure and life-threatening hemorrhagic diathesis. Hitherto, this has required prior laparotomy. A laparotomy is also added when the tumor extends presacrally into the pelvis. The presacral region is, however, difficult to access. A laparoscopic-assisted approach seems to offer a solution for both problems. Methods: A laparoscopic-assisted approach was used in five patients with SCT. In one neonate, it was used to interrupt the arterial blood supply only; in the other four patients, it was used to dissect the internal extension of the tumor. Results: Laparoscopic interruption of the median sacral artery proved to be simple in the neonate with a large, external, mainly solid SCT. In three of the remaining four patients with presacral extension of the tumor, good visualization and dissection of the intrapelvic portion of the tumor was obtained. In one patient, the procedure had to be converted because of a lack of working space due to extensive intraabdominal growth of the tumor. Conclusion: A laparoscopic-assisted approach seems to be ideal for SCT. It provides the opportunity to interrupt the median sacral artery before the dissection. Moreover, it enables far better access to the presacral area than the conventional surgical approach when the SCT extends presacrally into the pelvis. Such a meticulous laparoscopic dissection may improve the functional results.
Laparoscopy Children Sacrococcygeal teratoma
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Altman, RP, Randolf, JG, Lilly, JR 1974Sacrococcygeal teratoma: American Academy of Pediatrics Surgical Section Survey—1973.J Pediatr Surg9389398PubMedGoogle Scholar
Bax, NMA, van der Zee, DC 1998Laparoscopic clipping of the median sacral artery in huge sacrococcygeal teratomas.Surg Endosc12882883CrossRefPubMedGoogle Scholar
Havranek, P, Hedlund, H, Rubenson, A, Guth, D, Husberg, M, Frykberg, T, Larsson, LT 1992Sacrococcygeal teratoma in Sweden between 1987 and 1989: long-term functional results.J Pediatr Surg7916918Google Scholar
Hoehn, T, Krause, MF, Wilhelm, C, Lattermann, U, Rueckauer, KD 1999Fatal rupture of a sacrococcygeal teratoma during delivery.J Perinatol19596598CrossRefPubMedGoogle Scholar
Murphy, JJ, Blair, GK, Fraser, GC 1992Coagulopathy associated with large SCT.J Pediatr Surg2713081310PubMedGoogle Scholar
Rintala, R, Lahdenne, P, Lindahl, H, Siimes, M, Heikinheimo, M 1993Anorectal function in adults operated for benign sacrococcygeal teratoma.J Pediatr Surg2811651167PubMedGoogle Scholar
Serlo, W 1984Total rupture of giant sacrococcygeal teratoma.Z Kindechir39405406Google Scholar
Skinner, MA 1997Germ cell tumors.Oldham, KTColombani, PMFoglia, RP eds. Surgery of infants and children.Lippincott-RavenPhiladelphia653662Google Scholar
Teitelbaum, D, Teich, S, Cassidy, S, Karp, M, Cooney, D, Besner, G 1994Highly vascularized sacrococcygeal teratoma: description of this atypical variant and its operative management.J Pediatr Surg2998101PubMedGoogle Scholar