The laparoscopic approach to sacrococcygeal teratomas

Original article


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 


  1. 1.
    Altman, RP, Randolf, JG, Lilly, JR 1974Sacrococcygeal teratoma: American Academy of Pediatrics Surgical Section Survey—1973.J Pediatr Surg9389398PubMedGoogle Scholar
  2. 2.
    Bax, NMA, van der Zee, DC 1998Laparoscopic clipping of the median sacral artery in huge sacrococcygeal teratomas.Surg Endosc12882883CrossRefPubMedGoogle Scholar
  3. 3.
    Bentley, JFR 1968Coccygeal teratoma (sacrococcygeal tumour).Rob, CSmith, R eds. Operative surgery: pediatric surgery; vol V, pt 2. 2nd ed.ButterworthsLondon824829Google Scholar
  4. 4.
    Boemers, TM, van Gool, JD, de Jong, TP, Bax, KM 1994Lower urinary tract dysfunction in children with benign sacrococcygeal teratoma.J Urol151174176PubMedGoogle Scholar
  5. 5.
    Bond, SJ, Harrison, MR, Schmidt, KG, Silverman, NH, Flake, AW, Slomick, RN, Anderson, RL, Warsof, SL, Dyson, DC 1990Death due to high output cardiac failure in fetal sacrococcygeal teratoma.J Pediatr Surg2512871291PubMedGoogle Scholar
  6. 6.
    Chiba, T, Albanese, CT, Jennings, RW, Filly, RA, Farrell, JA, Harrison, MR 2000In utero repair of rectal atresia after complete resection of a sacrococcygeal teratoma.Fetal Diagn Ther15187190CrossRefPubMedGoogle Scholar
  7. 7.
    Garcia, AM, Morgan, WM III, Bruner, JP 1998In utero decompression of a cystic grade IV sacrococcygeal teratoma.Fetal Diagn Ther13305308CrossRefPubMedGoogle Scholar
  8. 8.
    Graf, JL, Albanese, CT, Jennings, RW, Farrell, JA, Harrison, MR 2000Successful fetal sacrococcygeal teratoma resection in a hydropic fetus.J Pediatr Surg3514891491CrossRefPubMedGoogle Scholar
  9. 9.
    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
  10. 10.
    Hoehn, T, Krause, MF, Wilhelm, C, Lattermann, U, Rueckauer, KD 1999Fatal rupture of a sacrococcygeal teratoma during delivery.J Perinatol19596598CrossRefPubMedGoogle Scholar
  11. 11.
    Kay, S, Khalife, S, Laberge, JM, Shaw, K, Morin, L, Flageole, H 1999Prenatal percutaneous needle drainage of cystic sacrococcygeal teratomas.J Pediatr Surg3411481151PubMedGoogle Scholar
  12. 12.
    Lam, YH, Tang, MH, Shek, TW 2002Thermocoagulation of fetal sacrococcygeal teratoma.Prenat Diagn2299101CrossRefPubMedGoogle Scholar
  13. 13.
    Lindahl, H 1988Giant sacrococcygeal teratoma: a method of simple intraoperative control of hemorrhage.J Pediatr Surg2310681069PubMedGoogle Scholar
  14. 14.
    Malone, PS, Spitz, L, Kiely, EM, Brereton, RJ, Duffy, PG, Ransley, PG 1990The functional sequelae of sacrococcygeal teratomas.J Pediatr Surg25679680PubMedGoogle Scholar
  15. 15.
    Murphy, JJ, Blair, GK, Fraser, GC 1992Coagulopathy associated with large SCT.J Pediatr Surg2713081310PubMedGoogle Scholar
  16. 16.
    Rintala, R, Lahdenne, P, Lindahl, H, Siimes, M, Heikinheimo, M 1993Anorectal function in adults operated for benign sacrococcygeal teratoma.J Pediatr Surg2811651167PubMedGoogle Scholar
  17. 17.
    Serlo, W 1984Total rupture of giant sacrococcygeal teratoma.Z Kindechir39405406Google Scholar
  18. 18.
    Skinner, MA 1997Germ cell tumors.Oldham, KTColombani, PMFoglia, RP eds. Surgery of infants and children.Lippincott-RavenPhiladelphia653662Google Scholar
  19. 19.
    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

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  1. 1.Department of Pediatric Surgery, Wilhelmina Children’s HospitalUniversity Medical Center Utrecht, P.O. Box 85090, 3508 AB UtrechtThe Netherlands

Personalised recommendations