This video presents the case of a nonverbal, medically complex 7 year-old prepubertal female with who underwent laparoscopic ovarian cystectomy for an incidental finding of 9cm complex ovarian cyst. Her past medical history included developmental and growth delay, myelomeningocele, hydrocephalus with a VP shunt, neurogenic bowel and neurogenic bladder. The patient did not express symptoms. Serial imaging for renal surveillance revealed an anechoic ovarian cyst with internal septations with vascularity that increased in size from 3.8 cm to 9.4 cm over 8 months. Tumor markers were negative and there was low pre-operative concern for malignancy. The patient underwent uncomplicated laparoscopic ovarian cystectomy and final pathology was consistent with a mature cystic teratoma. No immature elements or malignancy were present. The case was performed at a large academic pediatrics hospital and was exempt from IRB approval.

This instructive surgical video highlights pre-operative, intra-operative, and post-operative considerations for a prepubertal pediatric patient as illustrated through the case of a medically complex 7-year-old undergoing laparoscopic ovarian cystectomy for a mature cystic teratoma. Evaluation and work-up of a complex ovarian mass in a child is reviewed, as well as medical, surgical, and psychosocial considerations for caring for this unique patient population. Prepubertal gynecologic anatomy is illustrated and reviewed as well as particular attention to surgical considerations for the prepubertal pediatric patient.