For decades, midline incision represented the standard surgical approach to managing ovarian tumors in children and adolescent females. Advancements in surgical techniques and development of new devices have brought a substantial change in pediatric surgery. As a consequence, minimally invasive surgery (MIS) is increasingly often used in carefully selected patients and represents a standard technique in established pediatric surgical centers. Likewise, young adolescents and children presenting with ovarian tumors may benefit from MIS.

However, despite well-known benefits provided by MIS, the technique is accepted as gold-standard treatment only for small to moderate-sized ovarian tumors and cysts. Many surgeons consider the limited workplace provided by MIS as a relevant problem, and as a consequence, MIS is not recommended to be used in tumors greater than 10 cm.1,8 The most dreaded potential complication is intraoperative rupture of a tumor of unknown nature, which could possibly cause dissemination of the disease.

The use of the Alexis wound protector-retractor (AWPR) is a typical example of MIS that may further improve the laparoscopic approach, managing the problem of safe removal of huge ovarian tumors. The AWPR provides 360 degrees of atraumatic circumferential retraction. It is a safe technique with satisfying cosmetic outcomes.2 To the best of our knowledge, there are only a few case reports including patients with ovarian tumors greater than 10 cm in diameter operated on with the use of the AWPR.3,4

We report the case of a 15-year-old female presenting with a giant cystic ovarian mass, which, on final pathology, turned out to be an immature teratoma. We performed a laparoscopic en block unilateral oophorectomy and salpingectomy using the AWPR.

The aim of our report is to consider and to encourage the use of the AWPR in operative management of huge ovarian tumors in young adolescents and children.