Removal of ovarian tumours vaginally new surgical experience aicog 2012
1. DR ASHOK ANAND
PROF AND HOU.
GRANT GOVT. MEDICAL COLLEGE AND SIR J.J.
GROUP OF HOSPITALS,MUMBAI.
2.
3. Ovarian neoplasm is commonest tumour
found in women.
Normal functioning ovary produces cyst4-5
times every year.
In most cases, these functional masses are
self limiting and will resolve within 2-3
cycles.
Sometimes, they persist longer or become
larger than 5 cm size and transforms into
pathological condition.
4. With increasing age, incidence of functional
cyst increases.
Functional cysts are common features of
ovarian activity.
2% indoor hospital admissions are because of
ovarian neoplasms.
5. WOODRUFF(1976) has arbitrarily divided eras
of history in ovary and its neoplasms in 4
eras.
FIRST ERA: prior to 1800AD-AGE OF
IGNORANCE.
No physiological studies.
Ovarian surgery consists of only excision or
spaying.
ROBERT HOUSTON-GLASSGOW-credited for
first cystectomy in 1701 AD.
6. SECOND ERA(1800-1900AD)-AGE OF
SURGERY.
EPHRAIM MC DOWELL performed first
successful and documented ovariotomy.
JOHN LIZARS-1824-was considered as first
British ovarian resectionist.
No unanimous decision that the PATIENTS’s
with ovarian neoplasms be treated surgically.
8. FOURTH ERA(1950-1975 AD)-AGE OF
GROUPING.
WILLLIS-1953-gave a critical discussion of
different type of tumours and theories of
origin.
No work correlated clinical and pathological
type of ovarian tumours.
GAULT & BALOUBRAMNIUM-classified them.
9. 80% of ovarian neoplasms are cystic.
Malignancy is found only in 10-15% of cases.
65% of patients operated for ovarian
neoplasms had functional ovarian cysts.
10. Although the incidence of vaginal delivery is
decreasing, vaginal route is being
increasingly used surgically for removal of
intra abdominal and pelvic pathologies like
appendix or gall bladder by SURGOENS and
uterus by GYNAECOLOGISTS.
12. To remove ovarian tumours vaginally
To compare the results with that of
abdominal approach in relation with
OPERATIVE TIME, BLOOD LOSS, INTRA AND
POST OPERATIVE COMPLICATIONS, PAIN AND
HOSPITAL STAY.
13. All the women with ovarian tumours were
subjected for ultrasonography, CT scan&/or
MRI scan to know whether tumour is
1) unilateral or bilateral.
2) cystic, solid cystic or solid.
3) presence or absence of ascites.
Doppler studies were carried out to study the
vascularity of tumour.
Tumour markers like CA125,CEA,AFP or
B-HCG were also done .
14. All women were explained about sos
abdominal route.
Frozen section was arranged in all these
women with ovarian neoplasms.
15. Women with ovarian neoplasms who showed
only benign nature of the tumour based on
above investigations.
Women who were above 35 years of age &
required hysterectomy.
Women who have completed family .
Irrespective of size of tumour.
16. Period of study: 2009 to 2012
Total no. of patients operated: 206
Patients with OVARIAN MALIGNANCIES :36
Patients with BORDERLINE TUMOURS: 9
Patients with BENIGN SOLID TUMOURS: 27
Patients with BENIGN CYSTIC TUMOURS:182
Patients OPERATED VAGINALLY: 43
NONE of these tumours removed vaginally
were found MALIGNANT on histopathology
39. Practise makes the person perfect.
With more and more experience with NDVH,
we are more competent & confident to
perform different and difficult surgeries
vaginally
We gynaecologists are vaginal surgeons.
If we start doing whatever is necessary and
then do what is possible, one can do amazing
things.
No one can know when the miracles happen.
