Reports about giant, highly vascular sacrococcygeal teratoma (GHV-SCT) are un common. A boy with a prenatally diagnosed GHV-SCT was born at 34 weeks’gestati on weighing 3, 716 g. At birth, the GHV-SCT was 20 ×17 ×14 cm. After initial devascularization using an aortic snare, excision of the GHVSCT was started usin g monopolar diathermy, but hemorrhage from cutaneous collateral vessels was diff icult to control, and individual ligation of vessels was extremely time consumin g. The authors then used the Ligasure (LS) vessel sealing system (Valleylab, Bou lder, CO) to control intraoperative hemorrhage. Hemostasis was achieved easily w ith LS, without any need for vessel ligation; the operative field was dry and the efficiency of excision enhanced. Total operating time was 255 minutes, but excision of the GHV-SCT itself took only 16 minutes. The GHV-SCT weighed 1, 2 08 g or 325.1 g/kg body weight. Total blood loss was 77 mL or 20.7 mL/kg body weight, which was minimal compared with other cases in the literature. At the la st follow-up examination, 7 months after surgery, he remains well with no evide nce of recurrence. LS was extremely useful for controlling intraoperative hemorr hage in this case, and we strongly recommend its selective use for excising high ly vascular SCT. A boy with a prenatally diagnosed GHV-SCT was born at 34 weeks’gestati on weighing 3, 716 g. At birth, the GHV-SCT was 20 × 17 × 14 cm. After initial devascularization using an aortic snare, excision of the GHVSCT was started usin g monopolar diathermy, but hemorrhage from cutaneous collateral vessels was difficult to control, and individual ligation of vessels was extremely time consumin g. The authors then used the Ligasure (LS) vessel sealing system (Valleylab, Bouder, CO) to control intraoperative hemorrhage. Hemostasis was achieved easily w ith LS, without any need for vessel ligation; the operative field was dry and the efficiency of excision enhanced. Total operating time was 255 minutes, but excision of the GHV-SCT itself took only 16 minutes. The GHV-SCT weighed 1, 208 g or 325.1 g / kg body weight. Total blood loss was 77 mL or 20.7 mL / kg body weight , which was minimal compared with other cases in the literature. At the la st follow-up examination, 7 months after surgery, he remains well with no evide nce of recurrence. LS was extremely useful for controlling intraoperative hemorrhage in this case, and we strongly recommend its selective use for excising high ly vascular SCT.