Ovarian Tissue Collection for Fertility Preservation in Children | Ten-item, anonymous multiple-choice survey | 18 centres in England & Wales | provide ovarian procurement for cryopreservation | Ovarian Harvest (performed annually) | 39.3% of centers <10 cases | 32.1% of centers >20 cases | 82% standard 3-port laparoscopy | 7% single-port laparoscopy | Ligasure™ (44%) | Harmonic Scalpel™ (18.5%) | 96% total oophorectomy | 82% use the umbilical port site for retrieval | Conclusion: Significant variation in ovarian procurement methods for cryopreservation calls for research to establish a standardized best practice for optimal outcomes. | https://pubmed.ncbi.nlm.nih.gov/38480030/ | Source: Braungart S et. al. | Department of Paediatric Surgery, Royal Hospital for Children Glasgow, UK | Leeds Teaching Hospitals NHS Trust, Leeds, UK | @EmGootee MD | @StayCurrentMD | Cincinnati Children's | Journal of Pediatric Surgery
Ovarian Tissue Collection for Fertility Preservation in Children: The Need for Standardised Surgical Practice Guidance
Infographic · Sep 2024 · 1 min read
In brief
In brief
This UK national survey of 18 pediatric centers reveals significant variation in surgical techniques for ovarian tissue collection in prepubertal girls at risk of treatment-related infertility. Most centers perform laparoscopic total oophorectomy, but approaches differ in energy devices, retrieval methods, and port placement, highlighting the need for evidence-based surgical guidelines.
- No standardized surgical guidelines exist for ovarian tissue cryopreservation in prepubertal girls at risk of treatment-related infertility.
- Significant practice variation exists across UK centers: 82% use 3-port laparoscopy, but energy device choice varies widely (Ligasure 44%, Harmonic 18.5%).
- 96% of surgeons perform total oophorectomy rather than partial resection for fertility preservation tissue banking.
- Annual case volumes are low (39% of centers perform <10 cases/year), raising questions about surgical expertise concentration and outcomes.
- Standardized surgical protocols are needed to optimize tissue quality and fertility preservation outcomes in this vulnerable population.
Written by the GCMD Library team from the infographic.
A teal and yellow infographic with illustrated medical professionals performing surgery. The layout flows top to bottom, featuring a map of England and Wales, survey icon, anatomical illustration of ovary, and surgical team illustrations. Key statistics are highlighted in white and yellow text boxes against the teal background, with a yellow conclusion banner at the bottom.
Sarah Braungart, Sheila Lane, Christian M Becker, Nicholas Alexander
Background: Chemotherapy, pelvic radiotherapy (including total body irradiation) and novel compounds used to treat children and teenagers with benign or malignant diseases can lead to impaired fertility. For prepubertal female patients at high risk of treatment-related infertility, upfront storage of ovarian tissue is increasingly being recognised as standard of care. No surgical guidelines exist to ensure best practice technique. We reviewed current UK practice to assess surgical management.
Methods: A ten-item, anonymous multiple-choice survey was distributed to the lead surgeons in all paediatric centres in England/Wales undertaking ovarian procurement for cryopreservation.
Results: There are currently 18 centres in England and Wales that provide ovarian procurement for cryopreservation. Responses were received from 100% of the invited paediatric surgical oncology centres in England and Wales. 39.3% of participants stated that in their centre <10 cases of ovarian harvest are performed annually. In 32.1% of centres >20 cases are undertaken per year. In 64% of centres surgery is performed by a paediatric surgeon with interest in oncology or fertility preservation. The majority of cases were performed by a Consultant or Senior Registrar (89%). Regarding the surgical technique, 82% of respondents stated they gain access to the abdominal cavity using standard 3-port laparoscopy, 7% use single-port laparoscopy. Most frequently used energy devices for ovary/ovarian tissue resection were Ligasure™ (44%) and Harmonic Scalpel™ (18.5%). 96% of respondents perform a total oophorectomy, 1 respondent stated they perform a hemi-oophorectomy. 53% stated they place the ovary into a retrieval bag only if the ovary was too big for easy removal via the camera port, 28.5% always place it in a retrieval bag. Most surgeons use the umbilical port site for retrieval (82%).
Conclusion: This national survey shows significant heterogeneity in the surgical management of ovarian procurement for cryopreservation. To ensure best outcomes, research into the various surgical methods is necessary to provide data for a standardised best practice approach.