Laparoscopic assisted extracorporeal ovarian harvest: A novel technique to optimize ovarian tissue for cryopreservation in young females with cancer

Abstract

Background

Advances in pediatric cancer therapy have improved the long-term survival for many children with cancer. The awareness of quality of life aspects, specifically fertility preservation, has become a reality for many of these families and children. Ovarian tissue cryopreservation has emerged as an available fertility option for young females with cancer. Safe and effective removal of ovarian tissue in these girls is paramount. We report a laparoscopic assisted extracorporeal ovarian harvest technique that achieves this goal.

Operative technique

We place a 5 mm port at the umbilicus and in the right lower quadrant. Under laparoscopic guidance we place a 12 mm port in the left suprapubic area. Utilizing the 12 mm port site a monofilament traction suture is placed through the left ovary. The traction suture is used to translocate the ovary to an extracorporeal position via the 12 mm port site. Ovarian tissue is then excised utilizing standard surgical technique with the scalpel. Hemostasis is obtained and the capsule is closed with a running absorbable suture. The ovary is placed back in its native position laparoscopically.

Conclusions

The use of this extracorporeal ovarian harvesting technique is a safe and effective method to optimize removal and minimize tissue injury. Utilization of this technique, may have potential benefit to the young female with cancer.

Introduction

Cancer therapy have improved the long-term survival for many children with cancer. The 5-year overall survival rate for childhood cancer has increased from 58% in children diagnosed between 1975 and 1977 to 83% in those diagnosed between 2008 and 2014 [1]. The awareness of quality of life aspects, specifically fertility preservation, has become a reality for many of these families and children. Mainstay fertility preservation options for females undergoing gonadotoxic treatment typically include embryo and oocyte cryopreservation. However, for prepubertal patients or when urgent treatment is needed, ovarian tissue cryopreservation has emerged as the only available fertility option for this group of patients [2], [3]. Successful studies documenting live births following this procedure in adult woman, and in at least 10 children, has led to a dramatic increase in the practice worldwide [4], [5]. The oncofertility consortium has recently reported that ovarian tissue cryopreservation is a standard of care fertility option in young females with cancer [6], [7].

Most ovarian harvesting techniques for cryopreservation employ oophorectomy. Our specialty has also reported this technique [8]. However, prediction of which patient will clearly benefit from ovarian cryopreservation remains a challenge and outcome data may be decades away. Because of this, some groups are adopting a more conservative harvesting approach with a more limited harvest and resection [9]. The objective in this report is to describe a novel extracorporeal ovarian harvest strategy that is safe, effective and may allow for more optimal tissue preservation in selected young females with cancer.