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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

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
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.
rosie s physical examination
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
complementary diagnostic tools
Complementary Diagnostic Tools
  • Transrectal ultrasound

Characteristic “honeycomb”

appearance

  • Clinical diagnosis:
  • Granulosa cell tumor
what is a granulosa cell tumor
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
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.

ovarian granulosa cell tumor
Ovarian (Granulosa Cell) Tumor
  • How to know

Behaviour

Rectal examination

Ultrasound

Hormons levels

Biopsy/aspiration

rosie s recommended treatment
Rosie’s recommended treatment

Surgical removal of the ovary (Ovariectomy)

  • Recover normal reprodutive activity
  • Avoid complications:
  • Ovaria torsion, adhesions, small colon rupture
ovariectomy through the vagina
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
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
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.

ovariectomy m i nimally invasive laparoscopic
Ovariectomy- Minimally Invasive (Laparoscopic)

In the Anesthetized

mare for very large

ovaries

Fischer, Eq. Diag& Surg

laparoscopy

slide14

Ovariectomy- Minimally Invasive (Laparoscopic)

In the standing mare

thorugh the flank for normal

or moderate size ovaries

Loesch, 2003. Comp Cont Educ Vet Pract

slide15

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).
ovariectomy p o tential complications
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

prognosis
Prognosis

Removal tumor.

Hormonal normalization

Normal reproductive activity

ONLY IF 1 OVARY IS REMOVED

minimally invasive elected for rosie
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 rosie s surgery
IN PREPARATION FOR ROSIE’S SURGERY
  • Clipping and scrubbing surgical area
  • Sedation
  • Local anesthesia
rosie s post operative care
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.

end result
END RESULT
  • Rosie is back to work with normal reproductive cycle and behavior