Ovarian Terratoma

Teratoma of the ovary is one of the types of germigenic tumors that has synonyms - embryo, tridermoma, parasitic fetus, complex cell tumor, mixed teratogenic formation, monodermoma. Judging by the variety of names, the teratoma as an ovarian tumor has not been fully studied, but its place has been fixed since 1961 in the international Stockholm classification, which is still used by modern surgeons and gynecologists.

In the ICE (international classification of ovarian tumors), teratogenic neoplasms are described in the second part, designated as lipid-cell tumors, where there is sub-item IV-germinogenic tumors: 

• Immature teratoma.
• Mature teratoma.
• A solid teratoma.
• Cystic teratoma (dermoid cyst, including dermoid cyst with malignancy).

Teratoma is a neoplasm consisting of various embryonic tissues - mature or undifferentiated derived cells from the embryonic layers. The tumor is localized in the zone where the finding of such tissues is atypical from the point of view of the anatomical norm. Teratogenic formations are predominantly benign, but their danger lies in asymptomatic development and, consequently, in late diagnosis, which can lead to an unfavorable outcome of tumor development and its treatment.

[1], [2], [3], [4], [5], [6]

Causes of ovarian teratoma

Etiology, the causes of the ovarian teratoma are being studied so far, there are several theoretical hypotheses about the origin of embryonic neoplasms, but none of them is basic and proven clinically and statistically.

The least criticism and questions are the version of abnormal embryogenesis, during which a chromosomal malfunction occurs. As a result, various germinogenic neoplasms, including teratomas, are formed from the polypotent epithelium.

Teratoma can develop in the zones of the "gill" slits and fusion of embryonic furrows, but it is most often localized in the ovaries and testicles, since its primary source is the highly specialized cells of the gonads (gonads).

The tumor is formed from primary embryonic sex cells (gonocytes) and consists of tissue that is not characteristic of the location of the teratoma. Structurally, the neoplasm may consist of skin flakes, intestinal epithelium, hair, bone, muscle and nerve tissue elements, that is, from the cells of one or all of the three embryonic sheets.

There is also a more exotic theory, called Fetus in fetu, that is, an embryo in an embryo. Indeed, in the practice of surgeons, there are cases when, for example, the germinal parts of the body are found in the brain tumor. Such a rare teratom is called - fetiform teratoma or parasitic tumor, which is formed due to abnormal coordination of stem cells and surrounding tissues. Obviously, there is a pathological "niche" at a certain stage of embryogenesis, during which a violation of the induction of two embryos develops. One is weaker and is absorbed by the tissues of the second, genetically more active. For the sake of justice, it should be noted that the causes of teratoma in the ovaries are unlikely to refer to fetal anomalies, rather they lie in chromosomal abnormalities at earlier terms - 4-5 weeks after conception.

[7], [8], [9], [10], [11], [12], [13],

Symptoms of ovarian teratoma

Symptoms of ovarian teratoma are rarely manifested in the initial stage of tumor development, and this is its danger. Clinically manifested signs of teratoma may indicate either its large size when there is pressure, displacement of nearby organs, or malignant growth and metastasis. Teratoid neoplasms do not affect the hormonal system and do not depend on it in general, although according to statistics they often begin to increase actively during the pubertal period, during pregnancy and with menopause. However, in most cases the tumor grows asymptomatically, it is not by chance that it has received a characteristic name - a "dumb" tumor. It is believed that the teratoma manifests manifestations at sizes exceeding 7-10 centimeters.

Possible manifestations and symptoms of ovarian teratoma: 

• Periodic feeling of heaviness in the lower abdomen.
• Dysuria - a violation of the process of urination.
• Violation of defecation, more often constipation, less often - diarrhea.
• Increase in the size of the abdomen in women of asthenic physique.
• With a large tumor and a twisting of the legs, a typical picture of the "acute abdomen" develops.
• Anemia (rare) with a large size of mature teratomas.

Among all varieties of teratoma, the most manifested dermoid cyst, which is prone to inflammatory processes, suppuration and complications. An inflamed dermoid can produce high fever, weakness, and quite intense pain in the abdomen. Torsion of the legs of the cyst is expressed by the clinic of pelvioperitonitis with irradiating down (in the leg, rectum) pains.

In general, the symptomatology of a teratoma differs little from the manifestations of other benign neoplasms.

Teratoma of the right ovary

Most often, the teratoma develops on one of the ovaries, that is, it is one-sided. Bilateral formations are extremely rare, only 7-10% of the number of diagnosed DOJ (benign ovarian tumors).

The question of "symmetry" of tumors is still a subject of ongoing discussions among practicing gynecologists and theoreticians. There is an unproven version, which says that the right ovary is more susceptible to tumor processes and diseases in principle. These include the teratoma of the right ovary, which is really determined by some data in 60-65% of all detected by the teratoma. The possible cause of this asymmetric formation of teratogenic formations is due to a more active blood supply to the entire right side of the abdominal area, since there is a liver, aorta, which feeds the artery of the ovary. In addition to the peculiarities of venous architectonics, the factor that can provoke a right-sided tumor process is considered to be the anatomical asymmetry of the ovaries, when the right is larger in size than the left from the birth. There is also another hypothesis - the anatomical proximity of the appendix of the cecum (appendix), the inflammation of which can affect the growth of the tumor (cysts).

Indeed, the symptoms of acute appendicitis may be similar to the symptomatology of the torsion of the foot of the dermoid cyst and vice versa, when the suppurative dermoid provokes an inflammation of the appendix. Otherwise, the clinic that accompanies the teratoma of the right ovary and the neoplasm of the same etiology in the left ovary does not differ from each other in the same way as the treatment. The only difference is in some difficulties in the differential diagnosis of right-sided neoplasms.

Teratoma of the left ovary

Teratoma of the left ovary, according to the unspecified statistical data, is 1/3 of all teratogenic formations of the ovaries, that is, it is less common than the teratoma of the right ovary. The version of the lateral asymmetry of the ovaries in principle, about their unevenly distributed functional activity, in particular ovulation, is subject to constant discussions among specialists. Some gynecologists are convinced that the left ovary is much "lazier" than the right ovulation, it occurs in it 2 times less often, respectively, it reduces the load. Further, as a consequence, a smaller percentage of the development of tumor processes and pathologies in principle. Indeed, the hypothesis that active organs are more vulnerable in terms of developing neoplasms exists and finds clinical evidence. However, the teratoma of the left ovary is not considered a statistical argument of this theory, since according to recent observations, the frequency of its development is almost identical to the percentage of tumors of the right ovary. American physicians collected data on germ cell tumors for five years (from 2005 to 2010) and did not reveal any significant differences in the sense of lateral asymmetry.

Symptoms with left-sided teratoma of the ovary are similar to clinical manifestations of a tumor in the right. Signs appear only in the case of an increase in teratoma to a large size, with its inflammation, suppuration or twisting of the legs of mature formation - the dermoid cyst. Also, the obvious symptomatology may indicate a malignant course of the process, perhaps that the woman is already metastasizing.

Ovarian Teratoma and Pregnancy

Germinogenic neoplasms, like many other "mute" benign tumors, are detected at random - very rarely during preventive check-ups, as only 40-45% of women go through their statistics. More often than teratoma of the ovary is detected when put on an even for a pregnancy or with an exacerbation, inflammation of the tumor, when the clinical symptoms become apparent.

Many women who are planning the birth of a child are concerned about the question of how the ovarian teratoma and pregnancy are combined. The answer is one - almost all teratogenic tumors do not affect pathologically the development of the fetus and the state of the mother's health, under the following conditions: 

• Teratoma is defined as a mature (dermoid cyst).
• The size of the teratoma does not exceed 3-5 centimeters.
• Teratoma is not compatible with other tumors.
• The development, condition, and dimensions of the teratoma are under the constant supervision and control of the gynecologist.
• Teratoma is not accompanied by concomitant somatic pathologies of internal organs.

If a woman is diagnosed simultaneously with teratoma of the ovary and pregnancy, this means only one thing - you need to follow all the medical recommendations and not try to engage in self-medication. It is believed that germinogenic tumors are not able to influence the hormonal system, but rather it can activate teratoma growth, including during pregnancy. The enlargement of the uterus unambiguously entails a dystopia of internal organs, respectively, their displacement can provoke or infringement of the tumor, but most often among possible complications there is a torsion of the foot of the dermoid cyst. The danger is ischemic necrosis of the tumor tissue, rupture of the cyst. Therefore, a pregnant woman is sometimes shown laparoscopic surgery for the removal of teratoma, usually this action is possible only after the 16th week of pregnancy. Very rarely, surgery is performed urgently, when complications develop - suppuration of the dermoid cyst, torsion of its legs.

Laparoscopy of the ovarian teratoma is absolutely safe for both the mother and the fetus.

If the teratoma is small and does not cause functional disorders, it is observed throughout the entire gestation process, but must be removed either during labor during a caesarean section or after normal, natural births 2-3 months later. All kinds of teratomas are treated only in an operative way, it is better to get rid of such a neoplasm and neutralize the risk of malignancy of the tumor.

Cystic teratoma of the ovary

Cystic germ cell tumor, cystic ovarian teratoma is a dermoid cyst that is most often diagnosed at random, characterized by a benign course and a favorable prognosis in 90% of cases. Malignancy of the cystic tumor is possible only with its combination with malignant neoplasms - seminoma, chorionepithelioma.

Cystic teratoma, as a rule, is one-sided, occurring with equal frequency in both the right and left ovary, although there is information indicating more frequent right-sided localization.

The dermoid cyst (cystic mature teratoma) has an oval, rounded shape, a dense capsule structure and various sizes - from the smallest to the giant. Most often, the cyst is one-chambered, including embryonic tissue of the embryonic leaf - follicles, hair, parts of the nervous system tissue, muscular, bone, cartilaginous tissue, epithelium of the dermis, intestine, fat.

Clinical features of mature teratoma (cystic teratoma): 

• The most common among all tumors of the sexual glands in girls.
• Cystic teratoma of the ovary can be detected even in newborns.
• Localization - on the side, more often in front of the uterus.
• The tumor is unilateral in 90%.
• The most typical sizes of a mature teratoma are 5 to 7 centimeters: small ones are poorly diagnosed with ultrasound, gigantic ones are extremely rare.
• Mature teratoma is very mobile, does not manifest itself symptomatically, as it has a long leg.
• Because of the characteristic long leg, the dermoid cyst is at risk of torsion and ischemic necrosis of the tissue.
• The dermoid most often contains the tissues of the ectoderm (particles of the teeth, cartilaginous tissue, hair, fat).

Cystic mature ovarian dermoids are treated only by surgery, when enucleation (removal within healthy tissues) is performed using a low-traumatic, laparoscopic method. The prognosis after treatment is favorable in 95-98% of cases, malignancy is noted in rare cases - no more than 2%.

[14], [15], [16], [17], [18], [19]

Immature teratoma of the ovary

Immature teratoma of the ovary is often confused with a truly malignant neoplasm - teratoblastoma, although it is only a transitional stage to it. The structure of the immature teratoma consists of low-differentiated cells, and malignant ovarian tumors, as a rule, are composed of absolutely undifferentiated tissue of the embryonic sheets. Immature teratoma is considered capable of malignancy, but fortunately, it is extremely rare - only 3% of all diagnosed with teratomas, its confirmation is carried out only after postoperative histology.

Immature teratoma of the ovary often develops rapidly, consists of nerve and mesenchymal cells, localized in the anterior to the uterus zone. Rapidly increasing and metastasizing, the immature tumor is transformed into teratoblastoma.

Teratoblastoma characteristics: 

• The frequency of formation is 2-3% of all detected teratogenic tumors.
• The average age of patients is 18-25 years.
• The tumor is usually one-sided.
• Dimensions of immature grated graters are located within the limits of 5 to 40 centimeters.
• The surface is often smooth, elastic, in the section - solid or cystic structures.
• Immature tumors are rapidly necrotic, prone to hemorrhage.
• The composition of the tumor is specific, in it more often than in other teratomas, parts of the nervous tissue (hyperchromic cells), fibrillar inclusions are found. For immature teratomas, the inclusion of cartilaginous, epithelial tissue, and extodermal elements is not characteristic. 
• Immature tumor can be accompanied by gliomatosis (glial tumor) or chondromatosis of the abdominal cavity, endometriosis.

Tumors are characterized by rapid development, metastasis occurs by hematogenous or lymphatic pathway, forming metastases in nearby and distant internal organs

Symptoms with immature teratomas are nonspecific - weakness, fatigue, possible weight loss. The tumor has no effect on the hormonal system and the menstrual cycle, accompanied by pain in the already started, often terminal stage. Diagnosis should be maximally differential, as immature teratoma of the ovary is often similar to cystoma.

Treatment of an immature tumor is assumed only through an operation that is conducted irrespective of the patient's age. After surgical radical removal of the uterus, appendages, omentum, chemotherapy, radiotherapy, and the appointment of antitumor drugs are indicated. The course of the process is rapid, the forecast is extremely unfavorable because of the rapid metastasis of an immature teratoma.

It should be remembered that immature teratomas are potentially prone to malignancy, but with early diagnosis, the survival rate of patients is high enough. In addition, the sign of a truly malignant process is the combination of an immature teratogenic tumor with seminoma, chorionepithelioma.

Mature teratoma of the ovary

Mature teratogenic tumor differs from other types of teratomas by the type of chromosomal abnormality, it consists of differentiated, precisely defined derivatives of embryonic cells (germ layers). Mature teratoma of the ovary can be a cystic structure, but it can be single, solid - solid. 

1. Mature solid teratoma is mostly a benign tumor that has various sizes. The solid teratoma structure consists of cartilaginous, bone, and sebaceous elements and is highly dense, but not homogeneous - contains very small cystic vesicles filled with clear mucus 
2. Cystic mature teratoma (dermoid cyst) - this is a large tumor consisting of one or more cavity neoplasms. The cyst contains gray-yellow mucus, cells of the sebaceous, sweat glands, muscle tissue, between the cysts are denser cells of bone, cartilaginous tissue, rudimentary particles of teeth and hair. According to the microscopic structure, cystic mature tumors are not too different from solid teratomas, in these species characteristic organoid cells are found. However, a mature teratoma of the ovary of the cystic structure has a benign course and a favorable prognosis than a solid teratogenic tumor. Dermoids, as a rule, are not prone to malignancy and metastasis, their only danger is the torsion of the legs due to its length and the typical large size of the cyst itself. Treatment of dermoid cysts is only operative, it is indicated at any age of the patients and even during pregnancy with certain indications - the size of more than 5 centimeters, the threat of cyst ruptures, torsion of the legs, inflammation or suppuration.

Diagnosis of teratoma

Diagnosis of teratogenic tumors is more frequent as a result of spontaneous examinations, usually about another disease or during the registration for pregnancy. Diagnosis of the teratoma is described in various sources, but many sources tend to repeat non-specific information. This is due to the insufficient study of the teratoma in principle, its unspecified etiology. In addition, the symptoms of teratomas are not obvious, it is no coincidence that these tumors are called "silent tumors".

A typical cause for examination and comprehensive diagnosis may be suspected of a malignant neoplasm, thus measures are aimed at excluding or confirming ovarian cancer. The classic diagnostic strategy is the following: 

• Bimanual examination of the vagina is a classic method of diagnosis.
• Examination using gynecological mirrors.
• Ultrasound examination of the neoplasm and nearby ultrasound organs can be performed as a screening of intrauterine fetal pathology for early detection of neoplasms. Ultrasound is performed using a vaginal or abdominal sensor.
• X-rays, including organs in which metastasis is possible.
• Dopplerography.
• Computed tomography (CT) as a refining measure after ultrasound and x-ray.
• Puncturing the abdominal cavity under the supervision of ultrasound for cytology.
• Biopsy, histology.
• Irrigoscopy, sigmoidoscopy is possible.
• Definition of oncomarkers in the blood (presence of chorionic gonadotropin, alpha-fetoprotein), placental antigens.
• Chromocystoscopy to determine the stage of malignant tumors.

Diagnosis of ovarian teratoma, a complex of measures is a whole strategy, which is made on the basis of the primary clinical picture, most often nonspecific. The listed list of methods and procedures, as a rule, is used in case of severe symptomatology, characteristic for the teratitis complicated with inflammation, or for its malignant species. Specification of the diagnosis is the data of histological studies (biopsy).

[20], [21], [22], [23], [24], [25]

Treatment of ovarian teratoma

The choice of method, tactics of therapy, treatment of ovarian teratoma depend on the type of tumor, its morphological structure. Also, the factors that affect the treatment measures can be such parameters: 

• Stage of the tumor process.
• The size of the teratoma.
• Age of the patient.
• Concomitant diseases and immune status.
• The sensitivity of malignant teratoma to radiation therapy, chemotherapy.

Treatment of ovarian teratoma is always carried out in combination with antitumor or hormone therapy, it all depends on what type of tumor is diagnosed in a woman. 

1. Mature teratoma, which refers to one of the most favorable in the sense of prognosis, type of germogenic tumors, the dermoid cyst is treated only in an operative way. The earlier the tumor is removed, the less the risk of potential danger of overgrowth in the oncological process. As a rule, enucleation with laparoscopy is used, that is, the tumor is removed in the visually determined boundaries of healthy tissues. Also partial resection of the ovarian affected by the tumor is possible, such operations are performed in young women, girls to preserve the childbearing function. For women in the pre-menopausal period or with climax, a radical removal of the uterus and appendages is carried out to reduce the risk of degeneration of the teratoma into cancer. The vast majority of operations are carried out successfully, the forecast is favorable. Additional treatment is possible only for a more rapid recovery of the function of the operated ovary and as maintenance therapy in relation to the working, intact ovary. Relapses are extremely rare, however, if the tumor recurs, a radical operation is indicated 
2. Malignant species of teratom - immature tumor, terablobaloma are treated in a complex way, both surgically and with the help of chemotherapy, irradiation. Chemotherapy involves the passage of at least 6 courses, with the use of platinum (cisplatinum, platidiam, platinum). Irradiation can be relatively effective at the III stage of the oncoprocess. Also, in therapeutic activities, it is possible to include hormone therapy if the tumor contains receptors that are sensitive to hormonal drugs. Treatment of ovarian teratoma, defined as malignant, is inevitably complicated by side effects - nausea, vomiting, pain in the kidneys, oppression hemopoiesis, baldness, anemia. Despite the fact that many gynecologists believe that teratomas are not sensitive to chemotherapy, nevertheless all methods known to medicine are used in the treatment of potentially dangerous tumors or malignant neoplasms. Clinical remission is possible if the teratoma is detected at an early stage, complete remission is extremely rare, symptomatology disappears for a while, and the tumor diminishes in size by half. Unfortunately, the prognosis for malignant teratomas is disappointing. Treatment of an ovarian teratoma diagnosed as teratoblastoma does not work and mortality is very high due to rapid metastasis to vital organs.

Treating the symptoms of teratoma

Like other benign tumors, the teratoma is not symptomatic specific, but all types of germogenic neoplasms unite the main method of treatment - surgical removal of the tumor.

Treatment and symptoms of teratoma is a subject for detailed study by geneticists, gynecologists, surgeons. To date, the only method of neutralizing teratoma is surgery as the most effective way, minimizing the risk of malignancy of the tumor. As a rule, the treatment begins after the accidental detection of the tumor, less often on urgent indications, when the teratoma becomes inflamed, suppressed, the classical picture of the "acute abdomen" appears when the legs of the dermoid cyst are twisted. Also, a malignant teratogenic tumor is operated, and the treatment and symptoms of the teratoma can be simultaneous, which is typical for the terminal stage of the oncoprocess.

We list the most common types of teratomas and ways to treat them: 

• Dermoid cyst or mature teratoma (cystic mature teratoma). Dermoids in principle develop asymptomatically, they do not show pain and rarely cause functional disorders. However, large cysts can be impaired by proximity to adjacent internal organs, in addition, they are prone to inflammation, the cyst leg can be twisted and provoke necrosis of the dermoid tissue. Symptoms of complicated dermoid cysts include transient dysuria (impaired urination), constipation, periodic abdominal pain. Torsion of the legs is typical of the picture of the "acute abdomen", in which case the treatment and symptoms of the teratoma occur simultaneously, the operation is carried out in an emergency. Dermoids in pregnant women are also subject to removal, small cysts are left before delivery, after them, after 2-4 months, the teratoma must be removed. A benign teratoma that becomes inflamed during pregnancy, is operated according to the indications, but more often in the planned order after the 16th week. The prognosis of treatment is favorable in 95% of all cases, relapses practically do not occur 
• Immature teratomas prone to rapid transformation into another species - teratoblastoma, are characterized by the manifestation of symptoms characteristic of many malignant processes. Especially clearly, this teratoma signals itself with common metastases, usually in the terminal stage. Diagnosis is carried out already during the operation and after the procedure, when the material is subjected to cytological examination. Symptoms of malignant teratomas are increased fatigue, pain, intoxication of the body. It happens that the signs of disintegration and metastasis of a teratoma are similar to other acute somatic pathologies, therefore they are exposed to inadequate therapy, which does not bring relief and does not give a result. Just as a benign mature teratoma, an immature tumor is operated, the entire uterus and appendages are amputated, the omentum is removed. Then the malignant process undergoes radiation therapy, chemotherapy. The prognosis of treatment with malignant teratomas is unfavorable due to the rapid development of the tumor, but to a greater extent with its late diagnosis and neglect of the process.

Removal of teratoma of the ovary

Removal of benign neoplasms is considered a way to minimize the risk of malignancy of such tumors. Removal of teratoma of the ovary surgery can be performed in different volumes and accesses, depending on the size of the tumor, concomitant genital diseases, the patient's age, the presence or absence of extragenital pathology.

Women of childbearing age, if possible, make partial resection (cystectomy), maximally preserving the tissue of the ovary. The operation is performed by laparoscopic method with the use of a special device - an evacuation bag. Women at the perimenopausal age (climax) show supravaginal removal of the uterus, both appendages and omentum, such a voluminous operation solves the problem of prevention and reduction of the risk of malignization of the teratoma. The prognosis after the removal of a benign neoplasm is often favorable, relapses are extremely rare and speak either of an inaccurate species diagnosis of germinogenic formation, or of incomplete removal of the tumor.

Immature teratomas are also removed, but more often with laparotomy, when the tumor and the affected nearby tissues (lymph nodes) are also removed, possibly also visible in the procedure of metastasis.

In general, the removal of the ovarian teratoma by the endoscopic method is considered the gold standard in gynecology, surgery. Earlier, in the detection of DOJ (benign ovarian tumors), surgery was performed only as a laparotomy, while the ovary was damaged, which often lost its functionality, and was often removed along with the teratoma. The use of a high-frequency endoscopic instrumentation allows a woman to maintain a childbearing function, since surgical intervention is carried out in the most gentle way.

How is the ovarian teratoma removed? 

1. After the preparatory procedures, a small incision is made in the abdomen.
2. During the operation, the doctor performs an audit, examination of the abdominal cavity for possible malignant tumor development or bilateral development of the teratoma (occurs in 2025% of patients with teratomas).
3. During the removal of the tumor, material for histological examination is taken.
4. Removing the terato, the surgeon rinses (sanitizes) the inside of the peritoneum.
5. An intradermal suture is applied to the trocar incision with the help of absorbable filaments.
6. A day after the removal of the teratoma, the patient can get out of bed, walk alone.
7. Sutures are removed on the 3-5th day, before discharge.

The operation to remove the teratoma lasts no more than an hour, is performed under general anesthesia. After the operation, it is necessary to observe a sparing regimen, but not bed rest, sexual relations are recommended no earlier than a month after the removal of the teratoma.

Laparoscopy of ovarian teratoma

Laparoscopy as a method of surgical intervention is considered one of the most sought-after, more than 90% of all operations in the world for gynecological pathologies are performed with the help of laparoscopy. Laparoscopic surgery is a manipulation performed without cutting the peritoneum, this procedure is often called "bloodless." In the course of laparoscopic intervention, large open wounds are excluded, many postoperative complications inherent in voluminous laparotomy operations.

Laparoscopy can be a diagnostic or purely therapeutic procedure carried out on the organs of the abdominal cavity and small pelvis. Operative intervention occurs through small trocar punctures, through which an optical instrument is passed - a laparoscope.

Laparoscopy of the ovarian teratoma is also considered a "gold standard" in surgery, as it allows to preserve the patient's reproductive function and at the same time effectively neutralize tumor formations.

Endoscopic operation of the ovarian teratoma is performed using the same technology as laparoscopy of other gynecological pathologies. Although removal of a large teratogen cyst may result in the opening (perforation) of the capsule and the outflow of contents into the cavity, this does not cause serious complications in the form of profuse bleeding. The integrity of the ovary is restored after the teratoma has been harvested, usually with the help of bipolar coagulation ("welding"), with no additional seams required. Seams on the ovary are superimposed as a forming framework only for tumors of large sizes (more than 12-15 centimeters).

Laparoscopy of the ovarian teratoma can be quite voluminous when, as a result of an operational audit, it turns out that teratomas are spread multifariously or there is no healthy tissue around the tumor. In this case, even young women are shown ovariectomy (removal of the ovary) or adnexectomy (removal of the ovary and the fallopian tube).

What tests should I take before laparoscopy of the teratoma? 

• UAC is a general blood test.
• Blood chemistry.
• Blood clotting assay (coagulogram).
• Determination of Rh factor, blood group.
• Analysis for hepatitis, HIV, venereal diseases.
• General swab from the vagina.
• Electrocardiogram.
• Recommendations of related specialists in the presence of concomitant teratoma pathologies.

What kind of anesthesia is expected in a laparoscopic operation?

Laparoscopy uses endotracheal analgesia, anesthesia, which is considered one of the most effective and safe. In addition, another type of anesthesia can be used with laparoscopy, since the procedure involves the introduction of a special gas into the abdominal cavity, which does not allow the lungs to breathe freely at full strength. Endotracheal anesthesia provides compensatory breathing throughout the operation.

Laparoscopy of ovarian teratoma, benefits: 

• Lack of postoperative pain, typical for volumetric cavity operations, accordingly there is no need to apply strong analgesics.
• Lack of heavy blood loss.
• Malotravmatichnost for soft tissues, fasciae, muscles and so on.
• The possibility of additional specifying diagnosis in the optical survey of the cavity (including concomitant pathology).
• The ability to simultaneously operate the combined pathology revealed during the procedure.
• Reducing the risk of adhesions, since contact with the intestines is minimal, the risk of infertility development against the background of adhesions is accordingly neutralized.
• There is no cosmetic defect, as trocar punctures quickly heal and are practically not visible.
• There is no need for a long stay in the hospital.
• On the second day after laparoscopic surgery, patients can get up and move independently.
• Rapid recovery of general normal state of health and return of work capacity.