Ovariectomy

from Wikipedia, the free encyclopedia
Cysts on distant ovaries in a bitch

Under ovariectomy or ovariectomy ( ovariectomy ), also oophorectomy as well ovariotomy (actually "Ovarian incision") called, refers to the surgical removal of one or both ovaries (ovarian) due to diseases such as tumors or ovarian cysts or to reduce the production of hormones (eg in breast cancer ). In the case of benign tumors, partial removal is possible, otherwise the ovary (s) is completely resected, possibly with parts of the fallopian tube ( salpingo-oophorectomy ). When the ovaries and uterus (uterus) are removed, it is called an ovariohysterectomy .

history

The first known oophorectomies were carried out by the American country doctor and surgeon Ephraim McDowell (1771-1830), who in 1809 in Danville (Kentucky) surgically removed an ovarian tumor weighing approximately 10 kilograms and subsequently performed at least three more ovariectomies for ovarian cysts or ovarian tumors until 1817 reported. He was the first to have successfully performed an oophorectomy. The patient Jane Todd Crawford had urged him to have the procedure and had ridden nearly 100 km to McDowell in Danville for it. She survived the procedure, which supposedly took place without anesthetics, by 32 years and died in 1842 at the age of 78. The surgeon and obstetrician Nathan Smith (1762–1829) performed an ovariotomy in 1821 for the solitary removal of a large ovarian cyst. The first successful removal of the uterus and ovaries was achieved in 1863 by the anatomist and gynecologist Eugène Koeberlé (1828–1915), who worked at the Clinique de la Toussaint in Strasbourg until 1880 . From 1863 ovariotomies were also performed in Spain; for the first time by Federico Rubio y Galí . In 1865 the surgeon Thomas Spencer Wells (1818–1897) had already performed 114 ovariotomies and in 1876 Jakob Heinrich Hermann Schwartz performed an ovariotomy for the first time under aseptic conditions. According to Martz, the first ovariectomy in a patient with breast CA was performed on June 15, 1895 by George Thomas Beatson .

Methods of ovariectomy

There are several surgical methods that are commonly used to remove the ovaries.

laparoscopy

The Laparoscopy is a minimally invasive procedure, which is performed through a small incision in the abdominal wall. The operational risks are minimized compared to other surgical methods. Studies with horses and dogs have shown that laparoscopic surgery has the fewest complications during ovariectomy.

laparotomy

Laparotomy is the classic surgical method in which the abdominal wall is opened to remove the ovaries.

Colpotomy

In a colpotomy, the ovaries are accessed through an incision in the vagina.

Consequences of the ovariectomy

The bilateral removal of the ovaries represents castration, after which the fertility is no longer given. The ovaries produce important sex hormones , including estrogen , progesterone, and androgen . These hormones not only affect fertility, but also control other physical and psychological functions. The bilateral removal of the ovaries and the associated hormone deficiency can lead to physical complaints such as dizziness or migraines and nausea and also cause psychological complaints such as altered sensations and sensory perceptions or even depression .

If the uterus is removed along with the ovaries, menopause sets in abruptly, and women often complain of typical menopausal symptoms such as sweating, dry mucous membranes, mood swings and insomnia. Hormone replacement therapy can be used to counteract the physical and mental discomfort after an ovariectomy. Treatment with artificial estrogens and progesterone or gestagens is common.

Ovarian remnant syndrome can develop if residual ovarian tissue remains .

Prophylactic ovariectomy

A prophylactic ovariectomy if there is an increased risk of gynecological tumors, for example in the case of mutations in the BRCA genes, is controversial. The administration of artificial hormones can alleviate the symptoms that occur after the removal of the ovaries, but it also carries the risk of causing hormone-dependent tumors.

literature

  • Roche Lexicon Medicine . 5th edition. Urban & Fischer Verlag, Munich 2003. ISBN 3-437-15150-9
  • TR Rebbeck et al .: Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. In: N Engl J Med. , 2002 May 23, 346 (21), S: 1616-1622, PMID 12023993 .
  • Peter Schneck: Ovariotomy. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 1085.

Individual evidence

  1. Barbara I. Tshisuaka: McDowell, Ephraim. In: Werner E. Gerabek u. a. (Ed.): Encyclopedia of medical history. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 899 f.
  2. Ephraim McDowell: Three cases of extirpation of diseased ovaria. In: Eclect. Repert. Analyte. Rev. Volume 7, 1817, pp. 242-244.
  3. IM Rutkow: Ephraim McDowell at the world's first successful ovariotomy. In: Arch. Surg. Volume 134, 1999, p. 902.
  4. August Schachner: Ephraim McDowell, "Father of ovariotomy" and founder of abdominal surgery . Lippincott, Philadelphia 1921, Text Archive - Internet Archive . The operation on Crawford in 1809 is on p. 66 f. described.
  5. ^ Nathan Smith: Case of ovarian dropsy, successfully removed by a surgical operation. In: American Medical Recorder , Vol. 5, 1822, pp. 124-126.
  6. Eugène Koeberlé: extirpation de l'uterus et des ovaires. In: Gaz. méd. Strasbourg. Volume 23, 1863, p. 101.
  7. Barbara I. Tshisuaka: Koeberlé, Eugène. In: Werner E. Gerabek u. a. (Ed.): Encyclopedia of medical history. 2005, p. 770.
  8. G. Kispert: About the ovariotomy in Spain from 1863–1885. In: Centralblatt für Gynäkologie. Volume 10, No. 12, March 20, 1886, pp. 177 f.
  9. Thomas Spencer Wells: Diseases of the Ovaries: their diagnosis and treatment. London 1865; 2nd edition 1872.
  10. ^ Bettina A. Bryan: Wells, Sir Thomas Spencer. In: Werner E. Gerabek u. a. (Ed.): Encyclopedia of medical history. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 1471.
  11. G. Martz: The hormonal therapy of malignant tumors . Heidelberg Pocket Books, Volume 41, Springer-Verlag (1968)
  12. vetline.de
  13. vetline.de
  14. hormontherapie-wechseljahre.de
  15. kup.at (PDF)