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Laparoscopic Removal of an Ovarian Granulosa Cell Tumor

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

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Laparoscopic Removal of an Ovarian Granulosa Cell Tumor

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  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. OvariectomyThrough 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, 2003. Comp Cont Educ Vet Pract

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

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

  18. 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)

  19. IN PREPARATION FOR ROSIE’S SURGERY • Clipping and scrubbing surgical area • Sedation • Local anesthesia

  20. OPERATING ROOM SET UP FOR ROSIE

  21. STERILE SURGICAL FIELD

  22. VIDEO OF ROSIE’S PROCEDURE 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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