Presentation on theme: "Laparoscopic Removal of an Ovarian Granulosa Cell Tumor Antonio M. Cruz Diplomate American College of Veterinay Surgeons."— Presentation transcript:
Laparoscopic Removal of an Ovarian Granulosa Cell Tumor Antonio M. Cruz Diplomate American College of Veterinay Surgeons
Rosie`s History (Horses 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.
Rosies 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
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).
What do I notice with a Granulosa Cell Tumor? It is a Hormonal active tumor My Mare has…. Stallion-like behaviour Anestrus behaviour. Persistent estrus behaviour. Difficulty getting pregnant because of….. OR
Ovarian (Granulosa Cell) Tumor How to know Behaviour Rectal examination Ultrasound Hormons levels Biopsy/aspiration
Rosies recommended treatment Surgical removal of the ovary (Ovariectomy) Recover normal reprodutive activity Avoid complications: Ovaria torsion, adhesions, small colon rupture
Options for Removal of Ovary (ovariectomy)
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.
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.
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.
Ovariectomy - Minimally Invasive (Laparoscopic) In the Anesthetized mare for very large ovaries Fischer, Eq. Diag& Surg laparoscopy
In the standing mare thorugh the flank for normal or moderate size ovaries Loesch, Comp Cont Educ Vet Pract 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 Ovariectomy - Minimally Invasive (Laparoscopic)
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
Prognosis Removal tumor. Hormonal normalization Normal reproductive activity ONLY IF 1 OVARY IS REMOVED
MINIMALLY INVASIVE ELECTED FOR ROSIE Laparoscopic ovariectomy in standing mare. BEFORE THE SURGERY Food withheld for 24 hours (rectal examination pre- surgery confirmed sufficient emptying of the intestine)
IN PREPARATION FOR ROSIES SURGERY Clipping and scrubbing surgical area Sedation Local anesthesia
OPERATING ROOM SET UP FOR ROSIE
STERILE SURGICAL FIELD
VIDEO OF ROSIES PROCEDURE Click on image
Rosies Post-Operative Care Antibiotics for 3 days. Antiinflammatories for 3 days. Discharged from hospital 1 day after surgery. Exercise recommendations: 1 st week: stall rest 2 nd week: Stall rest + hand walking / turn out in small paddock 3 rd –4 th weeks: turn out. Gradual return to normal exercise.
END RESULT Rosie is back to work with normal reproductive cycle and behavior