Treatment is indicated if the diagnosis is in question, the cyst persists, in the case of ovarian torsion,or if the patient is symptomatic. Laparoscopy is becoming the favored approach by most pediatric surgeons for the treatment of ovarian cysts. All surgical procedures for ovarian cysts should spare functional ovary as much as is technically possible. Simple cysts can be fenestrated, but complex or functional cysts should be excised, with the preservation of the remaining ovary by careful dissection. The laparoscopic approach for adnexal masses can be performed in an acceptable manner, with comparable results to an open approach, plus the cosmetic advantages of minimally invasive surgery, which is an important aspect for the treated patients.
Elective endoscopic diaphragmatic hernia repairs have been reported. But endoscopic surgery was regarded unsuitable for emergency repair of diaphragmatic hernia in ventilated newborn children in bad general condition. We report a new method for inflation-assisted reduction and thoracoscopic repair of congenital diaphragmatic hernia diaphragmatic in a vitally endangered neonate. From three 2.7 mm to 5 mm accesses warmed low-pressure, low-volume CO2 was inflated into the thorax at 100 ml/min and 2 mm mercury. This allowed spontaneous reduction of the thoracic viscera into the abdomen and diaphragmatic suture with minimal handling. The 65-min procedure was tolerated well without perioperative deterioration. The baby was weaned off the respirator and breast-fed within 2 days, mediastinal shift normalized in 6 days. In suitable infants thoracoscopic repair and inflation-assisted reduction of thoracic contents is a more physiological access to congenital diaphragmatic hernia than laparoscopy or laparotomy.
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