Exoscope‐Assisted Ovarian‐Sparing Resection of Contralateral Mature Teratomas in Bilateral Pediatric Ovarian Disease: A Case Series

Background Bilateral ovarian tumors in pediatric patients present a surgical challenge requiring complete tumor removal while preserving sufficient ovarian tissue for endocrine function and future fertility. In bilateral disease, preservation is often feasible only on the ovary that retains salvageable parenchyma. Exoscope systems provide high‐definition magnified visualization of the operative field. To our knowledge, this is one of the first reports of exoscope‐assisted ovarian‐sparing surgery in pediatric patients. This study describes the technical feasibility of the technique and the completeness of tumor removal with preservation of ovarian parenchyma. Methods We conducted a retrospective case series of four patients with bilateral ovarian tumors who underwent exoscope‐assisted ovarian‐sparing surgery between 2020 and 2024 at a Brazilian pediatric cancer center. Eligible patients had imaging consistent with benign lesions and normal serum tumor markers. Surgical technique combined exoscopic magnification with intraoperative ultrasonography in open procedures. Results All patients had mature teratomas confirmed on final pathology. No intraoperative capsular ruptures occurred across the four preservation procedures. Mean follow‐up was 31.0 months (range 20–39). Two patients maintained regular spontaneous menses without hormonal supplementation. One patient developed clinical hypogonadism 8 months after surgery and received hormone replacement therapy, after which regular cycles resumed. One patient was not assessable for spontaneous menstrual recovery because continuous combined hormonal contraception was started after surgery at her request. No tumor recurrence occurred during follow‐up. Conclusions Exoscope‐assisted ovarian‐sparing surgery was technically feasible for the contralateral or remaining ovary in adolescents with bilateral mature teratomas. Spontaneous menstrual function was preserved in two of four patients, one required hormone replacement therapy, and one was not assessable. Controlled studies that include objective ovarian reserve markers and extended follow‐up are required before the added value of the exoscope can be established.