Himen imperforat en el diagnòstic diferencial de la massa vaginal / Himen imperforado en el diagnóstico diferencial de la masa vaginal / Imperforate hymen in the differential diagnosis of a vaginal mass

Introducció. L’himen és una membrana que envolta i cobreix parcialment l’introit vaginal. La presència d’un himen imperforat pot passar desapercebuda, donar símptomes obstructius de l’aparell genital i del tracte urinari en el període neonatal o presentar-se com a dolor abdominal amb amenorrea en l’adolescència, com a clínica més freqüent. Cas clínic. Presentem el cas d’una pacient de dos mesos amb diagnòstic d’himen imperforat, amb una fístula preauricular esquerra i una hèrnia umbilical concomitant. Davant de la manca de simptomatologia, s’adopta una conducta expectant fins als quatre anys; amb la persistència de l’hèrnia umbilical, s’indica la cirurgia correctora dels tres defectes, que es duu a terme sense incidències. Posteriorment, la pacient presenta una evolució correcta sense recidives. Comentari. L’obstrucció vaginal congènita sol detectar-se clínicament en la pubertat i és diagnosticada de forma poc freqüent durant el període de lactant. L’himen imperforat és la malformació congènita vaginal i l’anomalia obstructiva de l’aparell reproductor femení més freqüent, però no és l’única; per aquest motiu, és important fer un correcte diagnòstic diferencial de les masses vaginals, per donar el millor tractament dirigit i evitar una morbimortalitat més alta dels pacients. (AU)

Introducción. El himen es una membrana que rodea y cubre parcialmente el introito vaginal. La presencia de un himen imperforado puede pasar desapercibida, dar síntomas obstructivos del aparato genital y del tracto urinario en el período neonatal o presentarse como dolor abdominal con amenorrea en la adolescencia, como clínica más frecuente. Caso clínico. Presentamos el caso de una paciente de dos meses con diagnóstico de himen imperforado, con una fístula preauricular izquierda y una hernia umbilical concomitante. Ante la ausencia de sintomatología, se adopta una conducta expectante hasta los cuatro años; con la persistencia de la hernia umbilical se indica la cirugía correctora de los tres defectos, que se lleva a cabo sin incidencias. Posteriormente, la paciente presenta una correcta evolución sin recidivas. Comentario. La obstrucción vaginal congénita suele detectarse clínicamente en la pubertad y es diagnosticada de forma poco frecuente durante el período de lactante. El himen imperforado es la malformación congénita vaginal y la anomalía obstructiva del aparato reproductor femenino más frecuente, pero no es la única; por este motivo, es importante la realización de un correcto diagnóstico diferencial de las masas vaginales para dar el mejor tratamiento dirigido y evitar una mayor morbimortalidad en los pacientes. (AU)

Introduction. The hymen is a membrane that surrounds and partially covers the vaginal entrance. The presence of an imperforate hymen may go unnoticed, give obstructive symptoms of the genital tract and urinary tract in the neonatal period, or most commonly present as abdominal pain with amenorrhea in adolescence. Case report. We present a two-month-old girl diagnosed with imperforate hymen, with a left preauricular fistula and a concomitant umbilical hernia. In the absence of symptoms, conservative management was followed until four years of age, when with the persistence of the umbilical hernia corrective surgery of the three defects was performed without complications. Comments. Congenital vaginal obstruction usually occurs clinically during puberty and is rarely diagnosed during infancy. Imperforate hymen is the most common congenital vaginal malformation and obstructive anomaly of the female reproductive tract, although not the only one; for this reason, it is important to make a correct differential diagnosis of a vaginal mass in children to optimize management. (AU)

Coexistència de la malaltia de Wilkie i la síndrome del trencanous / Coexistencia de enfermedad de Wilkie y síndrome del cascanueces / Simultaneous occurrence of Wilkie and nutcracker syndromes

Introducció. La síndrome de l’artèria mesentèrica superior,o malaltia de Wilkie, i la síndrome de compressió de lavena renal esquerra, o síndrome del trencanous, són pocfreqüents. Normalment estan provocades per una compressió extrínseca del duodè o de la vena renal esquerra, respectivament, a causa d’una disminució de l’angle entrel’artèria mesentèrica superior i l’aorta.Cas clínic. Adolescent de 15 anys que va consultar a urgències per dolor abdominal de cinc mesos d’evolució localitzata l’epigastri, acompanyat de vòmits, proteïnúria i pèrdua depes. La pacient havia consultat prèviament en altres centresi s’havien descartat patologies urgents quirúrgiques. Es vacompletar l’estudi amb una tomografia computada abdominal amb diagnòstic de síndrome de l’artèria mesentèricasuperior i síndrome del trencanous. La pacient va ingressara la planta d’hospitalització i es va tractar de forma conservadora amb una dieta hipercalòrica; el trànsit intestinal i laproteïnúria van millorar, i va poder ser remesa a domicili icontrolada ambulatòriament de forma multidisciplinària.Comentari. Els problemes secundaris a la compressió aortomesentèrica poden donar quadres compatibles amb la síndrome de l’artèria mesentèrica superior i la síndrome deltrencanous. El diagnòstic d’aquests quadres pot resultarcomplex per la incidència baixa i per la simptomatologiainespecífica que els caracteritza. El tractament conservador representa la primera línia de tractament, però en alguns casos pot no ser suficient. Per tot això és necessarifer un maneig multidisciplinari d’aquests pacients. (AU)

Introducción. El síndrome de la arteria mesentérica superior o deWilkie y el síndrome del cascanueces son poco frecuentes. Normalmente están producidos por una compresión extrínseca delduodeno o de la vena renal izquierda, respectivamente, debido a una disminución del ángulo entre la arteria mesentérica superior yla aorta.Caso clínico. Adolescente de 15 años que consultó a urgencias pordolor abdominal de cinco meses de evolución localizado en epigastrio, acompañado de vómitos, proteinuria y pérdida de peso. Lapaciente había consultado previamente en otros centros descartando patologías urgentes quirúrgicas. Se completó el estudio conuna tomografía computarizada abdominal con diagnóstico de síndrome de la arteria mesentérica superior o de Wilkie y síndrome delcascanueces. La paciente ingresó en planta de hospitalización y setrató de forma conservadora con una dieta hipercalórica con mejoría del tránsito intestinal y de la proteinuria, y pudo ser remitida adomicilio y controlada ambulatoriamente de forma multidisciplinar.Comentario. Los problemas secundarios a la compresión aortomesentérica pueden dar cuadros compatibles con el síndrome de laarteria mesentérica superior o de Wilkie y el síndrome del cascanueces. El diagnóstico de estos cuadros puede resultar complejo por subaja incidencia y por la sintomatología inespecífica que los caracteriza. El tratamiento conservador representa la primera línea de tratamiento, pero en algunos casos puede no ser suficiente. Por estosmotivos es necesario un manejo multidisciplinar de estos pacientes. (AU)

Introduction. The superior mesenteric artery syndrome or Wilkiesyndrome and the nutcracker syndrome are rare. They are normallycaused by extrinsic compression of the duodenum or the left renalvein respectively, due to a narrowing of the angle between the superior mesenteric artery and the aorta.Case report. A 15-year-old girl presented to the emergency roomwith a five-month history of abdominal pain located in the epigastrium, accompanied by vomiting, proteinuria, and weight loss. Thepatient had previously consulted in other centers, and urgent surgical conditions were ruled out. The study was completed with anabdominal computed tomography scan, which led to the diagnosisof superior mesenteric artery or Wilkie syndrome, and nutcrackersyndrome. The patient was admitted to the hospital and treatedconservatively with a hypercaloric diet with improvement in intestinal transit and proteinuria. She was discharged to continue thefollow-up with a multidisciplinary team. Comment. Problems secondary to aortomesenteric compression cangive symptoms like superior mesenteric artery or Wilkie syndromeand nutcracker syndrome. The diagnosis of these conditions canbe complex due to their low incidence and the non-specific symptomatology that characterizes them. Conservative treatment represents the first line of treatment, but in some cases it may not beenough. For these reasons, multidisciplinary management of thesepatients is necessary. (AU)

Síndrome neuroléptico maligno en la urgencia pediátrica / Neuroleptic malignant syndrome in pediatrics. A case report

El síndrome neuroléptico maligno es una urgencia pediátrica con una elevada morbimortalidad, relacionada con alteración de sistema de neurotransmisión dopaminérgico. Se caracteriza por hipertermia junto con hipertonía muscular, alteración autonómica y de los niveles de conciencia. Un diagnóstico precoz es imprescindible para prevenir complicaciones comunes como la broncoaspiración, desgaste, escaras, procesos infecciosos y cambios neuropsiquiátricos. El tratamiento debe incluir en medidas generales de soporte y terapéutica farmacológica sintomática. Pese a que la mayoría de los casos descritos corresponden a población adulta, también se ha descrito en niños y adolescentes. Presentamos un caso de síndrome neuroléptico maligno en un adolescente de 12 años con encefalopatía y tetraparesia espática secundario al cese de la administración de baclofeno

Neuroleptic malignant syndrome is a pediatric emergency with high morbidity and mortality, related to an alteration of the dopaminergic neurotransmission system. It is characterized by hyperthermia along with muscular hypertonia, dysautonomia, and altered level of consciousness. An early diagnosis is essential to prevent common complications such as bronchoaspiration, wear, bedsores, infectious processes, and neuropsychiatric changes. Treatment should include general support measures and symptomatic pharmacological therapy. Although most of the cases described correspond to the adulthood, it has also been described in children and adolescents. We present a case of neuroleptic malignant syndrome in a 12-year-old adolescent with encephalopathy and spastic tetraparesis secondary to the cessation of baclofen administration

Acute Acalculous Cholecystitis Due to a Primary Epstein Barr Virus Infection in a Pediatric Patient.

Epstein-Barr virus (EBV) is estimated to infect more than 98% of adults worldwide and is one of the most common human viruses. Acute acalculous cholecystitis (AAC) of the gallbladder is an atypical complication of infectious mononucleosis caused by EBV. Conservative management has been described in the context of AAC caused by EBV. A surgical approach must be considered in the case of acute complications such as perforation or gallbladder gangrene. We present the case of a 10-year-old female patient with AAC due to infectious mononucleosis syndrome caused by primary EBV infection.

Epiploic Appendagitis and Omental Infarction as Rare Causes of Acute Abdominal Pain in Children.

Omental infarction and epiploic appendagitis are rare causes of acute abdominal pain in the pediatric population. Radiological evaluation is necessary to establish a specific diagnosis and to differentiate appendicitis from these conditions as they can be often managed conservatively without surgical intervention.

Fimosi refractària a tractament mèdic amagant una balanitis xeròtica obliterant / Fimosis refractaria a tratamiento médico escondiendo una balanitis xerótica obliterante / Refractory phimosis due to balanitis xerotica obliterans

INTRODUCCIÓ: La balanitis xeròtica obliterant és una malaltia crònica inflamatòria progressiva de baixa incidència en la població pediàtrica. CAS CLÍNIC: Es presenta un pacient de 4 anys afectat de fimosi greu I aspecte xeròtic del prepuci que no respon a tratament tòpic amb corticoides. Davant la sospita de balanitis xeròtica obliterant es practica una postectomia completa, I l'anatomia patològica confirma el diagnòstic. COMENTARI: És important conèixer aquesta malaltia en l'edat pediàtrica ja que el seu diagnòstic de sospita és clínic I pot comportar greus complicacions per als pacients. La refractarietat al tractament mèdic amb corticoides tòpics, la recidiva de la fimosi en pacients intervinguts, l'aparició de lesions blanquinoses en la mucosa prepucial o el gland I l'estenosi meatal són complicacions possibles que ens han de fer sospitar aquesta entitat. El tractament de les lesions en pacients intervinguts previament de fimosi amb diagnòstic posterior de balanitis xeròtica obliterant pot ser mèdic I de forma ambulatòria amb pomada de corticoides. És necessari un seguiment estricte d'aquests pacients per detectar possibles complicacions més greus, com l'estenosi meatal

INTRODUCCIÓN: La balanitis xerótica obliterante es una enfermedad crónica inflamatoria progresiva de baja incidencia en la población pediátrica. CASO CLÍNICO: Se presenta un paciente de 4 años afectado de fimosis grave y aspecto xerótico del prepucio que no responde a tratamiento tópico con corticoides. Ante la sospecha de balanitis xerótica obliterante, se realiza una postectomía completa y la anatomía patológica confirma el diagnóstico. COMENTARIO: Es importante el conocimiento de esta enfermedad en la edad pediátrica ya que su diagnóstico de sospecha es clínico y puede conllevar graves complicaciones para los pacientes. La refractariedad al tratamiento médico con corticoides tópicos, la recidiva de la fimosis en pacientes intervenidos, la aparición de lesiones blanquecinas en mucosa prepucial o glande y la estenosis meatal son complicaciones posibles que nos deben hacer sospechar esta entidad. El tratamiento de las lesiones en pacientes previamente intervenidos de fimosis con diagnóstico posterior de balanitis xerótica obliterante puede ser médico y de forma ambulatoria con pomada de corticoides. Es necesario un seguimiento estricto de estos pacientes para la detección de posibles complicaciones más graves, como la estenosis meatal

INTRODUCTION: Balanitis xerotica obliterans is a chronic progressive inflammatory disease of low incidence in the pediatric population. CASE REPORT: We present the case of a 4-year-old patient with stenosis and xerotic aspect of the foreskin that did not respond to medical treatment with topic corticosteroids. Balanitis xerotica obliterans was suspected, a complete postectomy was performed and the diagnosis was confirmed by pathology. COMMENTS: It is important to recognize this entity in children since its diagnosis is clinical and its mismanagement may result in several complications. The refractoriness to medical treatment with corticosteroid ointment, the recurrence of phimosis in operated patients, the appearance of whitish lesions in the mucosa of the foreskin or glans, and meatal stenosis are the complications that should raise suspicion of this entity. The treatment of lesions in patients who have previously undergone surgical treatment of phimosis can be medical with corticosteroid ointment. A close follow-up of these patients is required in order to detect severe complications such as meatal stenosis

Divertículo gástrico congénito como hallazgo casual en paciente de 16 años / Gastric diverticulum as an incidental finding in a 16-year-old patient

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Juxta-articular Myxoma of the Hip: A Rare Pediatric Tumor.

Juxta-articular myxoma (JAM) is a very rare myxoid tumor in pediatric age. JAM is frequently located at large joints, particularly in the knee, and most lesions present as palpable swelling sometimes associated with pain or tenderness. Only three cases of pediatric JAM have been reported in the literature to date. We describe a case of JAM in a 12-year-old boy, characterized by several unique aspects related to age, site of onset, size, and associated symptoms.

Role of intraluminal bowel echogenicity on prenatal ultrasounds to determine the anatomical level of intestinal atresia.

OBJECTIVE: To evaluate the correlation between different degrees of bowel intraluminal echogenicity showed by prenatal ultrasounds and the anatomic level of intestinal atresia. METHODS: We report three cases of intestinal atresia at different intestinal levels verified during the neonatal surgery with specific ultrasonographic prenatal features. Intensity of sonolucency was analyzed using the image-processing program ImageJ for quantitative measurements based on the gray-scale intensity values. RESULTS: A total of three cases are reported, a jejunal, an ileal and a colonic atresia. All cases showed intestinal dilatation. Both, jejunal and ileal atresia, showed two degrees of hypoechoic intestinal content, while colonic atresia showed hyperechogenic content dilated loop at prenatal ultrasound scan. CONCLUSIONS: We propose the use of prenatal ultrasounds echogenicity of intestinal dilated loop fluid content to help in determining the level of obstruction in bowel atresia. These are initial results, to be confirmed by a multicentric research with more cases.

Congenital pulmonary malformations: metabolomic profile of lung phenotype in infants.

BACKGROUND: The main hydrosoluble metabolites in three different human congenital pulmonary malformations are described by nuclear magnetic resonance (NMR) spectroscopy. METHODS: Bronchogenic cyst (BC), congenital lobar emphysema (CLE) and intrapulmonary sequestration (IPS), were analyzed with respect to a control sample. The extracted metabolites were submitted to high-resolution (1)H NMR-spectroscopy. RESULTS: Congenital lung malformations showed free choline, phosphocoline and myoinositol high levels. IPS and CLE were found increased in lactic acid/glucose ratio. Lactic acid and glucose values resulted to be more elevated in control sample. CONCLUSIONS: Congenital lung lesions showed different metabolomic profiles useful for early diagnosis.

[Fistulas of the lower urinary tract in children]. / Fistole del basso apparato urinario in età pediatrica.

A lower urinary tract fistula consist in an abnormal connection between bladder, urethra and adjacent abdominal organs or skin. There are several types of urinary fistulas in paediatric age and they may be congenital or acquired. Etiology may be due to embriological defects, infectious processes, malignant tumours, pelvic irradiation as well as complications following surgical procedures, especially postsurgical repair of hypospadia or epispadia. Clinical presentation depends on the type of fistula and diagnosis is based on signs, symptoms and radiological or endoscopic examinations. We performed PubMed research using terms such as lower urinary fistulae, urology and paediatrics and we consulted medical texts. We reviewed selected articles and used the relevant ones to perform our study concentrating on classification, diagnosis and treatment of different types of fistulas. Paediatric lower urinary fistulas are an uncommon pathology, but the knowledge of their etiology and classification is important to recognise them and lead the physician to an appropriate treatment, which is surgical in most cases.

Robotic-assisted surgery for excision of an enlarged prostatic utricle.

INTRODUCTION: Prostatic utricle is a rare malformation arising from incomplete regression of the Müllerian ducts. Diagnosis is easily made but management may be challenging. The minimally invasive approach has so far been considered the gold standard for surgical treatment. Many endoscopic and surgical procedures have been described for removal, but to date only few cases of robot-assisted procedures have been mentioned in the literature and there are no reports of redos. PRESENTATION OF THE CASE: We report the case of a giant prostatic utricle cyst successfully treated with robotic-assisted surgery two years after an unsuccessful first attempt at laparoscopic excision. No relapse was found at one year follow up. DISCUSSION: We were able to excise a retro-vescical structure in spite of adhesions caused by the previous surgery and the very large size of the diverticulum thanks to the high magnification and 3-D visualization available in robotic assisted laparoscopy. CONCLUSION: Robot assisted laparoscopy should be considered an advantageous technique for the treatment of prostatic utricle.

Robotic-assisted surgery approach in a biliary rhabdomyosarcoma misdiagnosed as choledochal cyst.

Rhabdomyosarcoma is a soft tissue malignant tumor affecting 1% of children from 0 to 14 years. Preoperative imaging may not always be diagnostic for hepatobiliary rhabdomyosarcoma and differential diagnosis with choledochal cyst (CC) could be difficult. We report a case of 2-years-old girl with a strange CC pattern of presentation. A grapelike lesion involving the choledochal and biliary ducts was easily and completely resected by robotic assisted surgery. Since no previous reports were available about oncologic safety of robotic approach, the porto-enterostomy was performed in open surgery. On histologic examination, the specimen revealed a botryoidembryonal rhabdomyosarcoma affecting both the common bile duct and the common hepatic duct. One year postoperatively the child is safe of tumor relapse. Robotic approach seems to be safe and advantageous to obtain a radical excision of the tumor at the porta hepatis, even in case of misdiagnosed malignant lesion mimicking a CC.

Pediatric robotic pyeloplasty in patients weighing less than 10 kg initial experience.

AIM: To report the feasibility and safety of a robotic-assisted laparoscopic pyeloplasty (RALP) in patients weighing <10 kg. MATERIALS AND METHODS: Three patients weighing between 5 and 8 kg who were affected by severe congenital ureteropelvic junction obstruction, including a child with solitary kidney, were subjected to RALP. Three trocars were placed; sutures and pyeloplasty remodeling were performed with interrupted stitches. A double J stent was inserted through a 2-mm transparietal angiocatheter to protect the pyelic suture. RESULTS: The procedures were all completed within 90 minutes, the "docking" time requiring 20 minutes. The patients were discharged on postoperative day 2, without any complications. CONCLUSIONS: Comprehensive assessment of pyelic suture in a very narrow field with 2 operative instruments is feasible and safe. Robotic pyeloplasty provides all the advantages of mini-invasive surgery with the added advantage of higher magnification and excellent surgical navigation in very small spaces and on fragile infant tissues.

Intrascrotal lipoblastoma in a ten year old: case report and review of literature.

Lipoblastoma is a rare benign soft tissue tumor encountered almost exclusively in infancy and early childhood. The location of tumors varies, but most occur in the extremities, trunk, head and neck. Less frequently, lipoblastomas have been reported in the mediastinum, the retroperitoneum and the inguinal region. Only 7 cases of lipoblastoma in the scrotum have been reported so far in the English literature, with none of the patients older than 8. We report an intrascrotal lipoblastoma in a 10 year-old boy. The differential diagnosis is discussed with reference to the literature.

Portal Hypertension in Childhood Bilateral Wilms' Tumor Survivor: An Excellent Indication for TIPS.

Introduction. Increased pressure in portal venous system is relatively a rare complication after chemoradiotherapy for Wilms' tumor (WT). In paediatric population, feasibility and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in portal hypertension nonresponsive to medical or endoscopic treatment have been recently advocated. We report a case of TIPS positioning in a 15-year-old girl with portal hypertension as a long-term sequel of multimodality therapy in bilateral WT. Case Report. Two-year-old girl was diagnosed for bilateral WT. Right nephrectomy with left heminephrectomy and chemoradiotherapy were performed. At 7 years of age, the first gastrointestinal bleeding appeared, followed by another episode two years later, both were treated successfully with beta-blockers. At 15 years of age, severe unresponsive life-threatening gastroesophageal bleeding without hepatosplenomegaly was managed by TIPS. Reduction of the portosystemic pressure gradient was obtained. Conclusion. TIPS positioning for portal hypertension in long-term tumors' sequel is feasible and could be considered as an additional indication in paediatric patients.

Isolated colon ischemia with norovirus infection in preterm babies: a case series.

INTRODUCTION: Norovirus infection with necrotizing enterocolitis has so far been reported as a specific tropism of the small bowel in premature newborns. CASE PRESENTATION: Three cases of premature newborns presenting with extensive isolated colonic ischemia due to norovirus infection are reported.Patient 1 was a Caucasian girl with a gestational age of 29+2 weeks. She had sudden onset of abdominal distension on the 30th day of life. Radiological signs of colonic pneumatosis were present 48 hours before perforation and stool analysis was positive for norovirus. On the 34th day, free air was detected on plain abdominal X-ray. At laparotomy, stenosis, necrosis and perforations involved the whole colon. The patient underwent ileostomy. A large colon resection and ileosigmoid anastomosis were done 3 months later.Patient 2 was a Caucasian boy with a gestational age of 28+3 weeks. On the 19th day, bloody stools with abdominal distension appeared. Stool analysis resulted positive for norovirus. A plain abdominal X-ray showed distended bowel loops. Antibiotic treatment was started. On the 32nd day due to the progressive deterioration of clinical conditions and the appearance of colic pneumatosis, a laparotomy was performed. Severe damage of the transverse colon and multiple areas of necrosis were found. Terminal ileostomy was performed. Six months later surgery consisted of mid-transverse colon resection as far as the splenic flexure, colocolic anastomosis and closure of ileostomy.Patient 3 was a Caucasian boy with a gestational age of 30 weeks. On the 44th day bloody-mucous stools appeared and stool analysis was positive for norovirus infection. Even with institution of antibiotic therapy clinical abdominal radiologic signs of colonic pneumatosis of the upper right quadrant were found. At the 70th day an explorative laparotomy showed dilated bowel loops and stenotic right colon and ileostomy was mandatory. Partial colectomy was later necessary and ileocolic anastomosis was performed. CONCLUSION: We hypothesize that norovirus infection may be responsible for severe, distinctive colonic lesions, even in premature newborn infants.

Robotic assisted surgery in pediatric gynecology: promising innovation in mini invasive surgical procedures.

STUDY OBJECTIVE: Robotic assisted surgery is not yet widely applied in the pediatric field. We report our initial experience regarding the feasibility, safety, benefits, and limitations of robot-assisted surgery in pediatric gynecological patients. DESIGN: Descriptive, retrospective report of experience with pediatric gynecological patients over a period of 12 months. SETTING: Department of Pediatric Surgery, IRCCS Policlinico San Matteo Foundation. PARTICIPANTS: Children and adolescents, with a surgical diagnosis of ovarian and/or tubal lesions. MAIN OUTCOME MEASURES: Robot assembly time and operative time, days of hospitalization, time to cessation of pain medication, complication rate, conversion rate to laparoscopic procedure and trocar insertion strategy. RESULTS: Six children and adolescents (2.4-15 yrs), weighing 12-55 kg, underwent robotic assisted surgery for adnexal pathologies: 2 for ovarian cystectomy, 2 for oophorectomy, 1 for right oophorectomy and left salpingo-oophorectomy for gonadal disgenesis, 1 for exploration for suspected pelvic malformation. Mean operative time was 117.5 ± 34.9 minutes. Conversion to laparatomy was not necessary in any of the cases. No intra- or postoperative complications occurred. CONCLUSION: Initial results indicate that robotic assisted surgery is safely applicable in the pediatric gynecological population, although it is still premature to conclude that it provides better clinical outcomes than traditional laparoscopic surgery. Randomized, prospective, comparative studies will help characterize the advantages and disadvantages of this new technology in pediatric patients.