Description

Minimal Access Surgery in Disorders of Sexual Differentiation – Insights by Dr. Reju Joseph Thomas at WALS 2025 Disorders of Sexual Differentiation (DSD) encompass a range of congenital conditions characterized by atypical chromosomal, gonadal, or anatomical sex development. The field of pediatric and adolescent surgery has seen remarkable advances in recent years, with minimal access surgery (MAS) playing a crucial role in the management of these complex conditions. At the World Association of Laparoscopic Surgeons (WALS) 2025 conference, Dr. Reju Joseph Thomas, a leading expert in pediatric laparoscopic surgery, provided groundbreaking insights into the application of MAS in DSD. Understanding Disorders of Sexual Differentiation DSD conditions include congenital adrenal hyperplasia (CAH), androgen insensitivity syndrome (AIS), mixed gonadal dysgenesis, and other intersex variations. These disorders can present with ambiguous genitalia, hormone imbalances, and potential fertility concerns, requiring a multidisciplinary approach for diagnosis and management. Traditionally, the management of DSD involved open surgical techniques, which, although effective, carried significant risks such as prolonged recovery times, higher infection rates, and post-operative complications. In contrast, MAS has revolutionized the field by offering minimally invasive solutions with enhanced precision and reduced morbidity. Advantages of Minimal Access Surgery in DSD Dr. Thomas emphasized the key benefits of MAS in the treatment of DSD, which include: - Enhanced Visualization: The high-definition cameras used in laparoscopic and robotic-assisted surgeries provide superior anatomical visualization, allowing for more precise dissection and identification of structures such as the gonads, uterus, and internal genitalia. - Reduced Post-Operative Pain and Scarring: Small incisions result in less pain, minimal scarring, and faster recovery times, making MAS a preferred choice for pediatric and adolescent patients. - Shorter Hospital Stays: Faster recovery enables earlier discharge, reducing hospital-related stress for both patients and their families. - Improved Surgical Outcomes: MAS minimizes blood loss, reduces the risk of infection, and leads to better cosmetic and functional outcomes. - Enhanced Fertility Preservation: Precision in surgical interventions is crucial for maintaining reproductive potential in patients with DSD. MAS facilitates careful gonadal preservation or removal when necessary, aligning with patient-specific needs. Cutting-Edge Techniques in MAS for DSD During his presentation at WALS 2025, Dr. Thomas highlighted several state-of-the-art MAS techniques employed in DSD management: - Laparoscopic Gonadectomy: Indicated for conditions such as complete androgen insensitivity syndrome, where undescended or dysgenetic gonads pose a malignancy risk. - Robotic-Assisted Gonadal and Uterine Procedures: The use of robotic systems enhances dexterity and precision in complex reconstructive surgeries. - Endoscopic Vaginoplasty: A minimally invasive approach to vaginal reconstruction in patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome or other forms of vaginal agenesis. - Laparoscopic Orchidopexy: Used to reposition undescended testes in cases of partial androgen insensitivity syndrome (PAIS) or mixed gonadal dysgenesis. - Minimally Invasive Urogenital Reconstruction: Addressing structural anomalies in the urinary and reproductive tracts with minimal tissue disruption.