Laparoscopic approach to sacrococcygeal teratomas

Abstract

Sacrococcygeal teratomas (SCT) have an incidence of 1:35,000 live born babies and are therefore the most common tumors in the newborn (Skinner 1997). Classically four anatomical types are distinguished: in type I most of the tumor is outside the body, in type II part of the tumor is outside the body but there is an important extension presacrally, in type III part of the tumor is also outside the body but the tumor extends into the abdomen, and in type IV the tumor is entirely presacral (Altman et al. 1974). There are two aspects of SCT in which a laparoscopic approach may offer a distinct advantage above classic surgery: first when the child is born with pending heart failure and/or severe coagulation disturbances, which occurs in large mainly solid SCT (Bax and van der Zee 1998; Murphy et al. 1992), and second when the tumor has a significant intrapelvic or intra-abdominal extension (Bax and van der Zee 2004), which occurs in more than 50% of the cases (Altman et al. 1974, Havranek et al. 1992). In the first circumstance, the situation may be improved by ligation of the median sacral artery, which is the main arterial supply to the tumor. This previously required a laparotomy (Bentley 1968; Lindahl 1988; Serlo 1984), but can now easily be performed laparoscopically (Bax and van der Zee 1998). This can be done as a separate initial operation in a very unstable child or can be done as the first phase just before resection. Ligation of the median sacral artery can also be advantageous when there is an important intrapelvic or intra-abdominal tumor component. Laparoscopy allows for a meticulous dissection of the intrapelvic or intra-abdominal part of the tumor, which is hard to achieve during open surgery. © Springer-Verlag Berlin Heidelberg 2008.