Ovarian Tissue Collection for Fertility Preservation in Children: The Need for Standardised Surgical Practice Guidance

Infographic · Sep 2024 · 1 min read

In brief

National UK survey reveals significant variation in surgical techniques for ovarian tissue harvest in prepubertal girls facing gonadotoxic cancer treatment. Despite 18 centers performing the procedure, no standardized guidelines exist for laparoscopic approach, energy device selection, or tissue handling, highlighting the need for evidence-based surgical protocols.

No standardized surgical guidelines exist for ovarian tissue procurement in prepubertal girls despite it becoming standard of care.
Significant practice variation exists across UK centers: 96% perform total oophorectomy vs. partial resection approaches.
Most centers (82%) use 3-port laparoscopy with Ligasure or Harmonic devices, but energy source choice varies widely.
Annual case volumes are low (39% of centers perform <10 cases/year), raising questions about surgical experience and outcomes.
Standardized best practice guidelines are urgently needed to optimize fertility preservation outcomes in this vulnerable population.

Written by the GCMD Library team from the infographic.

A three-column comparison layout with medical illustrations of esophageal procedures. Each column contains anatomical diagrams in blue and pink tones showing the esophagus and stomach, with surgical technique variations. Bar charts or percentage indicators display outcome metrics below each procedure illustration.

Sarah Braungart, Sheila Lane, Christian M Becker, Nicholas Alexander

Background: Chemotherapy, pelvic radiotherapy (including total body irradiation) and novel compounds used to treat children and teenagers with benign or malignant diseases can lead to impaired fertility. For prepubertal female patients at high risk of treatment-related infertility, upfront storage of ovarian tissue is increasingly being recognised as standard of care. No surgical guidelines exist to ensure best practice technique. We reviewed current UK practice to assess surgical management.

Methods: A ten-item, anonymous multiple-choice survey was distributed to the lead surgeons in all paediatric centres in England/Wales undertaking ovarian procurement for cryopreservation.

Results: There are currently 18 centres in England and Wales that provide ovarian procurement for cryopreservation. Responses were received from 100% of the invited paediatric surgical oncology centres in England and Wales. 39.3% of participants stated that in their centre <10 cases of ovarian harvest are performed annually. In 32.1% of centres >20 cases are undertaken per year. In 64% of centres surgery is performed by a paediatric surgeon with interest in oncology or fertility preservation. The majority of cases were performed by a Consultant or Senior Registrar (89%). Regarding the surgical technique, 82% of respondents stated they gain access to the abdominal cavity using standard 3-port laparoscopy, 7% use single-port laparoscopy. Most frequently used energy devices for ovary/ovarian tissue resection were Ligasure™ (44%) and Harmonic Scalpel™ (18.5%). 96% of respondents perform a total oophorectomy, 1 respondent stated they perform a hemi-oophorectomy. 53% stated they place the ovary into a retrieval bag only if the ovary was too big for easy removal via the camera port, 28.5% always place it in a retrieval bag. Most surgeons use the umbilical port site for retrieval (82%).

Conclusion: This national survey shows significant heterogeneity in the surgical management of ovarian procurement for cryopreservation. To ensure best outcomes, research into the various surgical methods is necessary to provide data for a standardised best practice approach.

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