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Laparoscopic Removal of an Ovarian Granulosa Cell Tumor

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Presentation on theme: "Laparoscopic Removal of an Ovarian Granulosa Cell Tumor"— Presentation transcript:

1 Laparoscopic Removal of an Ovarian Granulosa Cell Tumor
Antonio M. Cruz Diplomate American College of Veterinay Surgeons

2 Rosie`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.

3 Rosie’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 tumor Ovarian hematoma. Ovarian abscess. Pregnancy. - Anovulatory hemorragic follicle

4 Complementary Diagnostic Tools
Transrectal ultrasound Characteristic “honeycomb” appearance Clinical diagnosis: Granulosa cell tumor

5 What 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).

6 What do I notice with a Granulosa Cell Tumor?
It is a Hormonal active tumor My Mare has…. Difficulty getting pregnant because of….. Anestrus behaviour. Stallion-like behaviour OR Persistent estrus behaviour.

7 Ovarian (Granulosa Cell) Tumor
How to know Behaviour Rectal examination Ultrasound Hormons levels Biopsy/aspiration

8 Rosie’s recommended treatment
Surgical removal of the ovary (Ovariectomy) Recover normal reprodutive activity Avoid complications: Ovaria torsion, adhesions, small colon rupture

9 Options for Removal of Ovary (ovariectomy)

10 Ovariectomy - Through the vagina
Disadvantadges Done blindly Difficult control of hemorrhage. Difficult preparation for aseptic surgery. Risk for surgeon as it is done standing Possible complications (Incision uterine branch of urogenital artery, injuries of cervix, bladder or bowel, eventration). Adams, Atlas of Eq Surgery.

11 Ovariectomy -Through the flank
Standing in the sedated horse Lat. recumbency in the anaesthetized horse Disadvantadges. Poor Cosmetic results if incision scarring. Tension placed in mesovarium. Longer time of recovery (around 6 weeks). Adams, Atlas of Eq Surgery.

12 Ovariectomy Through the belly
Removal of ovaries up to 25 cm. Disadvantadges. General anesthesia. Long recovery ( 8-12 weeks). Increased incidence of post-operative colic Adams, Atlas of Eq Surgery.

13 Ovariectomy - Minimally Invasive (Laparoscopic)
In the Anesthetized mare for very large ovaries Fischer, Eq. Diag& Surg laparoscopy

14 Ovariectomy - Minimally Invasive (Laparoscopic)
In the standing mare thorugh the flank for normal or moderate size ovaries Loesch, Comp Cont Educ Vet Pract

15 Ovariectomy - Minimally Invasive (Laparoscopic)
Advantages Better 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). Disadvantages Specialized equipment Technical difficulty

16 Ovariectomy 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

17 Removal tumor. Hormonal normalization Normal reproductive activity
Prognosis Removal tumor. Hormonal normalization Normal reproductive activity ONLY IF 1 OVARY IS REMOVED

Laparoscopic ovariectomy in standing mare. BEFORE THE SURGERY Food withheld for 24 hours (rectal examination pre-surgery confirmed sufficient emptying of the intestine)

Clipping and scrubbing surgical area Sedation Local anesthesia



Click on image

23 Rosie’s Post-Operative Care
Antibiotics for 3 days. Antiinflammatories for 3 days. Discharged from hospital 1 day after surgery. Exercise recommendations: 1st week: stall rest 2nd week: Stall rest + hand walking / turn out in small paddock 3rd –4th weeks: turn out. Gradual return to normal exercise.

24 END RESULT Rosie is back to work with normal reproductive cycle and behavior

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