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.
 
Ethical Considerations and Patient-Centered Care
 
Dr. Thomas also emphasized the importance of ethical decision-making in DSD management. Given the sensitive nature of these conditions, patient autonomy, informed consent, and psychological support play a pivotal role. He advocated for a holistic approach involving pediatric endocrinologists, geneticists, psychologists, and ethicists to ensure that surgical decisions align with the patient’s well-being and future reproductive potential.
 
The Future of MAS in DSD Treatment
 
The field of MAS continues to evolve, with ongoing research focused on refining techniques, improving robotic-assisted procedures, and integrating artificial intelligence for enhanced precision. Dr. Thomas concluded his talk by highlighting the potential of regenerative medicine and tissue engineering in DSD treatment, which may pave the way for even less invasive and more effective therapeutic options.
 
In summary, minimal access surgery has emerged as a transformative approach in the management of disorders of sexual differentiation. With experts like Dr. Reju Joseph Thomas at the forefront, patients with DSD can now benefit from safer, more effective, and ethically sound surgical interventions, ensuring improved quality of life and long-term health outcomes.