Page 11 - World Association of Laparoscopic Surgeons - Journal

10.5005/jp-journals-10007-1149
Lakkanna Suggaiah et al
CASE REPORT
Laparoscopic Gonadectomy for Complete Androgen

Insensitivity Syndrome

Lakkanna Suggaiah, Usharani Rathnam, Preetham Raj

ABSTRACT normal and the vagina measured 5 cm in length, ending
Introduction: Androgen insensitivity syndrome is a form of male blindly. Family history revealed she was the only child
pseudohermaphrodite where the phenotype female has male with no similar complaints in the family. Transabdomino-
gonads and is genotypically male. pelvic ultrasound confirmed the absence of uterus and
Case report: We report a case of complete androgen ovary and presence of bilateral masses of 3 × 2.5 cm in
insensitivity syndrome in a 22-year-old who underwent
size, located near the internal ring of the inguinal canal.
laparoscopic gonadectomy.
Imaging studies noted absence of prostrate and seminal
Discussion: Androgen insensitivity syndrome is the most
vesicals.
common cause of male pseudohermaphroditism and third most
Karyotype report was 46 XY (Fig. 2). Serum FSH was
common cause of primary amenorrhea.
10.7 μ/ml, serum estradial was 88 pg/ml, all other hormonal
Conclusion: Laparoscopy is an effective method in androgen
parameters and tumor markers were within normal limits.
insensitivity syndrome treatment, mainly due to the increased
risk of malignant transformation of the testes. Psychosexual After standard peroperative preparation, operative
needs should be addressed along with low-dose hormonal laparoscopy was performed under GA. Pelvic and
therapy to maximize long-term success.
abdominal inspection revealed absent uterus and ovaries.
Keywords: Androgen insensitivity syndrome, Laparoscopic Bilateral gonads appearing as testis were attached near
gonadectomy.
the internal ring of both inguinal canals. The pedicles of
How to cite this article: Suggaiah L, Rathnam U, Raj P. gonads were coagulated with bipolar cautery and cut with
Laparoscopic Gonadectomy for Complete Androgen Insensitivity
laparoscopic scissors to prevent the spillage of cells and
Syndrome. World J Lap Surg 2012;5(1):54-57.
contamination. The gonads were placed in endobags and
Source of support: Nil
removed intact after extending the port (Figs 3 and 4).
Conflict of interest: None declared There was no complication during the operation. The
patient was discharged on the 3rd postoperative day after
INTRODUCTION
surgery.
Androgen insensitivity syndrome (AIS) was previously Gross pathology reports mentioned the tissue marked
called testicular feminization syndrome. Intersex is a rare as the right gonad measuring 3 × 5 × 2 cm with attached
X-linked recessive condition due to mutation at xq 11-q 12
localization on the androgen receptor gene. AIS is a form
of male pseudohermaphrodite where the phenotype female
has male gonads and is genotypically male. Importance of
this syndrome is development of testicular tumor especially
seminoma after puberty. The diagnosis is often based on
absence of uterus, cervix, tubes and a vagina of variable
length with nondysplastic testis.

CASE REPORT

A 22-year-old woman was admitted to ESIC Medical
College PGIMSR, Rajajinagar, Bengaluru, with complaints
of primary amenorrhea and infertility, referred to the
surgical department by gynecology department for bilateral
inguinal swelling. The patient was 175 cm tall, weighing
60 kg. External physical examination revealed well-
developed breasts, abundant scalp hair with scanty pubic
and axillary hair (Fig. 1). The vulva and perineum appeared Fig. 1: Thick long hair

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