Objective: Streak gonads in 46,XY or 45,X/46,XY gonadal dysgenesis are at increased risk for malignant transformation, thus requiring surgical extirpation by the third decade of life. Surgical removal has traditionally involved laparotomy, but more recently an operative laparoscopic approach has been possible. Methods: Two patients with XY gonadal dysgenesis and two with 45,X/46,XY mosaicism, each of whom were candidates for laparoscopic removal of streak gonads, are described. Results: Laparoscopic gonadectomy was performed in one case, laparoscopic adnexectomy in three cases. Selection of procedure depended on proximity of the streak gonad to the Fallopian tube. In all four cases complete removal of dysgenetic gonads was accomplished with minimal blood loss, rapid postoperative recovery, and minimal postoperative discomfort. No case required laparotomy, and in all four the uterus was left in situ for future use in assisted reproduction. Conclusion: Complete removal of dysgenetic gonads can be accomplished laparoscopically and is preferable to laparotomy. The uterus should remain in situ.
