Use of ICG navigation in organ-preserving resections of ovarian teratomas in children

Abstract

This study presents the first experience of indocyanine green imaging for ovarian tumors in girls to show how the development of new imaging technologies can change the treatment of this pathology. A retrospective analysis was conducted on the case histories of a 12-year-old girl and a 15-year-old girl with ovarian teratomas who were admitted with complaints of discomfort and pain in the lower abdomen. Ultrasound and computed tomography of the abdominal cavity revealed tumors with sizes of 40 42 38 and 60 54 38 mm in the right ovary for one girl and in the left ovary for the other girl. No increase in the concentration of tumor markers (alpha-fetoprotein, -chorionic gonadotropin, and Cancer Antigen 125) was recorded. Operations for the diagnosis of ovarian teratoma were performed laparoscopically using fluoroscopic control. The use of indocyanine green imaging was effective in determining the boundaries of the tumor and healthy ovarian tissues, making it possible to perform organ-sparing surgery. During the surgical intervention, no complications were observed in the form of bleeding from the ovarian parenchyma or damage to neighboring organs. Histological diagnosis established that the neoplasms belong to mature teratomas. The length of hospital stay was three days. Ultrasound examination performed six months after surgery showed no signs of disease recurrence. One of the patients exhibited regeneration of ovarian tissues comparable with the size of the contralateral ovary. In another girl, the affected ovary was about half the size. Thus, organ-preserving surgical treatment for ovarian teratomas in children is the method of choice. A fundamental innovation is the use of indocyanine green fluorescence technology to determine the boundaries of the spread of the tumor in order to resect it within healthy tissues.