Challenges in laparoscopic gonadectomy for complete androgen insensitivity syndrome with nonpalpable inguinal glands.

Introduction And Importance: Laparoscopic gonadectomy for nonpalpable glands in the inguinal canal, particularly in patients with Complete Androgen Insensitivity Syndrome (CAIS), presents technical challenges and is infrequently reported. While laparoscopic surgery in young women is minimally invasive and offers cosmetic advantages, it may require an additional inguinal incision depending on gonad location.

Case Presentation: A 16-year-old phenotypic female with a chief complaint of primary amenorrhea was diagnosed with 46, XY karyotype and CAIS. She was referred for a gonadectomy. MRI revealed the absence of a uterus, with the right gonad located in the abdominal cavity and the left gonad in the inguinal canal. After discussing the potential need for a secondary incision, a laparoscopic gonadectomy was performed with urological collaboration. During surgery, the gonads were located deep within the inguinal canal and were not palpable. Histopathological examination of the left testis was inconclusive. Four months later, a palpable mass was discovered in the left inguinal region, leading to removal of left testicular tissue via a secondary inguinal incision.

Clinical Discussion: This report highlights the importance of thorough preoperative imaging, collaborative surgical efforts between gynecologists and urologists, and the potential need for secondary surgical intervention when residual gonadal tissue is suspected.

Conclusions: Gonadectomy in patients with CAIS, who typically present to gynecologists due to their female gender identity, requires careful consideration of the potential need for secondary inguinal incisions, particularly in cases involving nonpalpable inguinal gonads.