Surgical considerations and challenges in the pediatric and adolescent gynecologic patient

• Published in: Best practice & research. Clinical obstetrics & gynaecology Vol. 48; pp. 128 - 136
• Main Authors: Chan, Serena H., Lara-Torre, Eduardo
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.04.2018
• Subjects: Adolescent; Gynecology; Laparoscopy; Pediatric; Surgery; Laparoscopy; Pediatric; Gynecology; Surgery; Adolescent
• ISSN: 1521-6934; 1532-1932
• DOI: 10.1016/j.bpobgyn.2017.10.007

It is important for practitioners to recognize that there are special considerations when performing gynecologic surgery in a pediatric or adolescent patient. A provider must be familiar with differences in anatomy, physiology, surgical technique, and psychosocial concerns. This can be challenging for a provider who does not routinely operate on patients in this population. A minimally invasive surgical approach is preferred in the pediatric and adolescent patient whenever possible. While a good command of laparoscopy in the adult patient is certainly a useful skill when operating on pediatric and adolescent patients, there are technical adaptations and challenges to consider. This chapter reviews the pre-operative preparation, operative technique and challenges, and post-operative care of the surgical pediatric and adolescent gynecologic patient. •Pelvic ultrasound and MRI are preferred for adnexal masses and Müllerian anomalies.•Anatomic differences in pediatric patients should be considered during laparoscopy.•Fertility preservation should be prioritized when operating on pediatric patients.•Pre-operative imaging should be considered for surgery for uterovaginal anomalies.•Multi-modal post-operative pain management is preferred in pediatric patients.