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. Rectal palpation: Enlarged left ovarium. Never been bred. Healthy otherwise.

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 Transrectal ultrasound Characteristic “honeycomb” appearance Clinical diagnosis: 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? 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 How to know Behaviour Rectal examination Ultrasound Hormons levels Biopsy/aspiration

Rosie’s 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

Ovariectomy - Minimally Invasive (Laparoscopic) In the standing mare thorugh the flank for normal or moderate size ovaries Loesch, 2003. 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 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

Removal tumor. Hormonal normalization Normal reproductive activity 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 ROSIE’S SURGERY Clipping and scrubbing surgical area Sedation Local anesthesia

OPERATING ROOM SET UP FOR ROSIE

STERILE SURGICAL FIELD

VIDEO OF ROSIE’S PROCEDURE Click on image

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 Rosie is back to work with normal reproductive cycle and behavior