Abstract
Ovarian tissue cryopreservation (OTC) provides children who face a fertility-threatening treatment an option to cryopreserve their ovarian tissue prior to receiving potentially sterilizing medical therapy. The technical details matter when removing an ovary for fertility preservation, even though the procedure itself is relatively straightforward. The ovary should be handled and treated with care as a potential organ for transplant. While there is no defined standard surgical technique for OTC, laparoscopic oophorectomy is a safe, proactive option for pediatric girls facing medical treatment with a high risk of fertility loss. Whenever possible, OTC should be coordinated under the same anesthesia with any additional necessary procedures.
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References
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Review Questions and Answers
Review Questions and Answers
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Q1.
Is there a defined surgical technique for the procurement of ovarian cortical tissue for OTC in children?
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A1.
No, there has not been one standard operation for ovarian cortical tissue harvest. Techniques described include ovarian cortical biopsy, unilateral or bilateral hemi-oophorectomy, unilateral oophorectomy, and oophorectomy with excision of the vascular pedicle.
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Q2.
What are important perioperative considerations before proceeding with OTC in pediatric patients?
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A2.
It is important to check preoperative laboratory studies, such as a complete blood count, prior to proceeding with OTC. This is crucial in children with hematologic pathology or those who have received previous chemotherapy who may have significant anemia or thrombocytopenia that requires correction preoperatively.
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Q3.
What are the anatomic differences between the adnexa of a prepubertal girl and a postpubertal girl?
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A3.
In infants and preadolescent girls, the ligament of the ovary is long, the mesovarium is often narrow, and the fallopian tube is located very close to the ovary. The average volume of a prepubertal ovary is 1 cm3 as compared to the 5–10 cm3 volume of a postpubertal ovary.
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Q4.
What are the key aspects to performing a laparoscopic unilateral oophorectomy for OTC in children?
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A4.
Laparoscopic unilateral oophorectomy for OTC should be carried out with minimal manipulation to the ovarian capsule, preservation of the ipsilateral fallopian tube, if possible, and division of the ovarian artery as the last step of the procedure in attempt to maintain the integrity of the ovary for cryopreservation and the presence of adnexal structures for potential future transplantation.
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Corkum, K.S., Rowell, E. (2019). Optimal Technique for Laparoscopic Oophorectomy for Ovarian Tissue Cryopreservation in Pediatric Girls. In: Woodruff, T., Shah, D., Vitek, W. (eds) Textbook of Oncofertility Research and Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-02868-8_10
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DOI: https://doi.org/10.1007/978-3-030-02868-8_10
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