Minimally invasive surgery for pediatric cases of large extraovarian teratoma with considerable solid component

Pediatric patients with large extraovarian teratomas with a significant solid component are usually treated using open surgery because the size of the intracorporeal cavity does not facilitate the manipulation of large tumors. Here, we describe the cases of 3 children who underwent minimally invasive surgery for large extraovarian teratomas (diameter > 10 cm), including 2 cases of retro- peritoneal teratoma and 1 case of a thoracic teratoma. All tumors had a large amount of sebaceous material that displaced other surrounding organs. Tumor volumes were reduced by intraoperative needle aspiration using a SAND balloon catheter with a double balloon that is designed to minimize the risk of spillage. Intraoperative needle aspiration of cystic content can provide sufficient working space and facilitates safe separation of the major vessels from the tumor. Treatment of large extra- ovarian teratomas by minimally invasive surgery involving skin incisions that result in a less noticeable scar, such as a Pfannenstiel incision or axillary incision, can achieve improved cosmetic outcomes.