Presentation on theme: "Laparoscopic Removal of an Ovarian Granulosa Cell Tumor"— Presentation transcript:
1Laparoscopic Removal of an Ovarian Granulosa Cell Tumor Antonio M. CruzDiplomate American College of Veterinay Surgeons
2Rosie`s History (Horse’s name and picture have been changed to protect identity) 10-year-old thoroughbred mare.Signs of stallion like behaviour last 2 weeks.Rectal palpation: Enlarged left ovarium.Never been bred.Healthy otherwise.
3Rosie’s Physical Examination Vital parameters within normal limits.Rectal examination confirmed a enlarged left ovarium of ~ 8 cm diameter.Possible diagnoses enlarged ovarium:- Tumor : Granulosa-theca cell tumor, cystadenoma, germ cell tumorOvarian hematoma.Ovarian abscess.Pregnancy.- Anovulatory hemorragic follicle
5What is a Granulosa Cell Tumor? Sex cord-stromal tissue bening tumor (malignant has also been reported).Most common ovarian neoplasia in mares (85% reprodutive tract tumors, 2.5%vequine neoplasms).Mature horses (also foals reported).Usually unilateral (Bilateral also reported).
6What do I notice with a Granulosa Cell Tumor? It is a Hormonal active tumorMy Mare has….Difficulty getting pregnant because of…..Anestrus behaviour.Stallion-like behaviourORPersistent estrus behaviour.
7Ovarian (Granulosa Cell) Tumor How to knowBehaviourRectal examinationUltrasoundHormons levelsBiopsy/aspiration
8Rosie’s recommended treatment Surgical removal of the ovary (Ovariectomy)Recover normal reprodutive activityAvoid complications:Ovaria torsion, adhesions, small colon rupture
10Ovariectomy - Through the vagina DisadvantadgesDone blindlyDifficult control of hemorrhage.Difficult preparation for aseptic surgery.Risk for surgeon as it is done standingPossible complications (Incision uterine branch of urogenital artery, injuries of cervix, bladder or bowel, eventration).Adams, Atlas of Eq Surgery.
11Ovariectomy -Through the flank Standing in the sedated horseLat. recumbency in the anaesthetized horseDisadvantadges.Poor Cosmetic results if incision scarring.Tension placed in mesovarium.Longer time of recovery (around 6 weeks).Adams, Atlas of Eq Surgery.
12Ovariectomy Through the belly Removal of ovaries up to 25 cm.Disadvantadges.General anesthesia.Long recovery ( 8-12 weeks).Increased incidence of post-operative colicAdams, Atlas of Eq Surgery.
13Ovariectomy - Minimally Invasive (Laparoscopic) In the Anesthetizedmare for very largeovariesFischer, Eq. Diag& Surglaparoscopy
14Ovariectomy - Minimally Invasive (Laparoscopic) In the standing marethorugh the flank for normalor moderate size ovariesLoesch, Comp Cont Educ Vet Pract
15Ovariectomy - Minimally Invasive (Laparoscopic) AdvantagesBetter visualization ovary and mesovarium.Decrease potential postsurgical complications.Tension free ligation of mesovarium.Standing technique: Not costs nor risk of anesthesia.Short recovery (2-3 weeks).DisadvantagesSpecialized equipmentTechnical difficulty
16Ovariectomy Potential Complications Post-operatory hemorrhage from mesovarium.Post-op pain, anorexia, depression.Incisional swelling, infections, dehiscense, eventration.Peritonitis.All of these are reduced during minimally invasive approaches
17Removal tumor. Hormonal normalization Normal reproductive activity PrognosisRemoval tumor. Hormonal normalization Normal reproductive activityONLY IF 1 OVARY IS REMOVED
18MINIMALLY INVASIVE ELECTED FOR ROSIE Laparoscopic ovariectomy in standing mare.BEFORE THE SURGERYFood withheld for 24 hours (rectal examination pre-surgery confirmed sufficient emptying of the intestine)
19IN PREPARATION FOR ROSIE’S SURGERY Clipping and scrubbing surgical areaSedationLocal anesthesia
23Rosie’s Post-Operative Care Antibiotics for 3 days.Antiinflammatories for 3 days.Discharged from hospital 1 day after surgery.Exercise recommendations:1st week: stall rest2nd week: Stall rest + hand walking / turn out in small paddock3rd –4th weeks: turn out.Gradual return to normal exercise.
24END RESULTRosie is back to work with normal reproductive cycle and behavior