Laparoscopic Intra-abdominal Cyst Surgeries

Laparoscopic surgery has both diagnostic and therapeutic advantages in the management of intra-abdominal cysts in children. Large cysts in small children pose technical challenges during laparoscopic surgery, requiring multiple incisions and advanced laparoscopic skills. This paper describes a novel laparoscopic technique using minimal manipulation for both aspiration and excision of the cyst. This simple, safe, and effective approach was used to achieve traction and facilitate excision of a large intra-abdominal cyst in a neonate and a young child.

Giant intra-abdominal cysts in children are rare and most commonly arise from the small bowel mesentery, the omentum, or the ovary. Optimal surgical management requires complete excision of these lesions. Although they are invariably benign, a full laparotomy has been the conventional approach for resection, often via a large midline incision given the size of these cysts. The advent of minimally invasive surgery has allowed resection of these cysts, without need for a full laparotomy, with the benefit of improved cosmesis, less postoperative pain, and shorter hospital stay.
However, laparoscopy can be technically challenging in small children with large intra-abdominal cysts. This is mainly due to lack of intra-abdominal space and poor ergonomics in relation to port placements in smaller children with large cysts. We describe a needle hitch technique, which facilitated excision of large intra-abdominal cysts in both a neonate and a young child.