Ovarian Tissue Collection for Fertility Preservation in Children: The Need for Standardised Surgical Practice Guidance
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Topic Overview
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.
Transcript
Is there standard practice for ovarian tissue collection for for telepreservation in children? I'm Alex Halpern a research fellow from Children's National and this is an article that you should know Bronngot at all distributed a survey to the surgeons at the 18 centers in England and Wales that perform ovarian tissue Preservation to try and answer this question. They found that a majority of cases were performed by a consulted or senior registrar Most respondents used three-poor laparoscopy while some used single-poor laparoscopy and the most common to use energy devices for ovarian tissue Resection with the ligature and the harmonic scalpel Nearly all surgeons perform the total u-frectomy. So it seems like there's a significant variation in the surgical management of these patients How do you perform these surgeries? Let us know in the comments below