[When may, should, must the ovary by removed--with which technique?].
The growing demand for minimally invasive operative processes and the unmistakable progress in pelviscopy, have led to an extension of the indications for minimally invasive surgery. At the same time, the operative treatment of ovarian cysts is the third most frequently performed pelviscopic operation. The indication for ovarectomy depends, above all, on anamnestic factors, the clinical findings and the results of pre-operative vaginal sonography. In the event of inadequate hormone secretion by the ovaries, the indication for organ removal should be generously applied. Vaginal sonography is not capable of proving or excluding the existence of a malignancy with 100% certainty. The average rate of ovarian carcinomas is 2.6% in case of smooth-walled, unicamerate cysts. Pelviscopy is also unable to differentiate reliably between benign and malignant ovarian tumours. With the aid of pelviscopic operative processes, a cystic ovarian tumour cannot be extirpated in toto with the necessary certainty. In spite of the conflicting results in the literature, an iatrogenic rupture of an early ovarian carcinoma can be expected to result in worsening the prognosis. The Department of Obstet. Gynecol. University of Göttingen, adopted the following procedure: 1. A (mini-) laparotomy with immediate section for microscopic examination is always performed on sonographically suspect ovarian tumours. 2. On smooth-walled unicamerate ovarian tumours > or = 3 cm which persist or fail to respond to treatment with oral contraceptives, (mini-) laparotomy is performed with complete extirpation of the cystic ovarian tumour and immediate section for microscopic examination; a conceivable alternative is, if possible, total pelviscopic extirpation of the ovarian cyst with immediate section for microscopic examination.(ABSTRACT TRUNCATED AT 250 WORDS)
Rath
W
W
Univ.-Frauenklinik, Göttingen.
Osmers
R
R
Kuhn
W
W
D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D010048:Ovarian Cysts / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010052:Ovariectomy / Q000379:methods*; D010053:Ovary / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography
Wann darf, soll, muss das Ovar entfernt werden--mit welcher Technik?