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

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