Ovarian teratoma

Ovarian teratoma is one of the types of germ cell tumors, which has synonyms - embryoma, tridermoma, parasitic fetus, complex cell tumor, mixed teratogenic formation, monodermoma. Judging by the variety of names, 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 gynecological surgeons.

In the ICO (International Classification of Ovarian Tumors), teratogenic neoplasms are described in the second part, designated as lipid cell tumors, where there is subparagraph IV - germ cell tumors:

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

Teratoma is a neoplasm consisting of various embryonic tissues – mature or undifferentiated derivatives of cells from the germ layers. The tumor is localized in an area where the presence 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, accordingly, in late diagnosis, which can lead to an unfavorable outcome of tumor development and its treatment.

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Causes of ovarian teratoma

The etiology and causes of ovarian teratoma are still being studied; there are several theoretical hypotheses about the origin of embryonic neoplasms, but none of them is basic and proven clinically and statistically.

The version of abnormal embryogenesis, during which a chromosomal failure occurs, causes the least criticism and questions. As a result, various germ cell neoplasms, including teratomas, are formed from the pluripotent epithelium.

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

The tumor is formed from primary embryonic germ cells (gonocytes) and consists of tissue that is not typical for the location of the teratoma. Structurally, the neoplasm may consist of skin scales, intestinal epithelium, hair, elements of bone, muscle and nerve tissue, i.e., cells of one or all three germ layers.

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

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Symptoms of ovarian teratoma

Ovarian teratoma symptoms rarely appear at the initial stage of tumor development, and this is where its danger lies. Clinically manifested signs of teratoma may indicate either its large size, when there is pressure, displacement of nearby organs, or a malignant course of growth and metastasis. Teratoid neoplasms do not affect the hormonal system and do not depend on it as a whole, although according to statistics, they most often begin to actively increase during puberty, pregnancy and menopause. However, in most cases, the tumor grows asymptomatically, it is no coincidence that it received a characteristic name - a "silent" tumor. It is believed that teratoma manifests itself with symptoms when the size exceeds 7-10 centimeters.

Possible manifestations and symptoms of ovarian teratoma:

• Periodic feeling of heaviness in the lower abdomen.
• Dysuria is a disorder of the urination process.
• Disruption of defecation, most often constipation, less often diarrhea.
• Increased abdominal size in women with asthenic body type.
• With a large tumor and torsion of the pedicle, a typical picture of an “acute abdomen” develops.
• Anemia (rare) with large mature teratomas.

Among all the varieties of teratoma, the most pronounced is the dermoid cyst, which is prone to inflammatory processes, suppuration and complications. An inflamed dermoid can cause high temperature, weakness, and quite intense painful sensations in the abdomen. Torsion of the cyst stalk is expressed by the clinical picture of pelvic peritonitis with pain radiating downwards (to the leg, rectum).

In general, the symptoms of teratoma are not much different from the manifestations of other benign neoplasms.

Teratoma of the right ovary

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

The issue of "symmetry" of tumors is still a subject of ongoing discussions among practicing gynecologists and theorists. There is an unproven version that states that the right ovary is more susceptible to tumor processes and diseases in general. These include teratoma of the right ovary, which, according to some data, is actually determined in 60-65% of all detected teratomas. A possible reason for such asymmetric formation of teratogenic formations is due to a more active blood supply to the entire right side of the abdominal region, since the liver and aorta, which feeds the ovarian artery, are located there. In addition to the peculiarities of venous architectonics, anatomical asymmetry of the ovaries is considered a factor that can provoke a right-sided tumor process, when the right one is larger than the left one from birth. There is another hypothesis - the anatomical proximity of the vermiform appendix of the cecum, the inflammation of which can affect the growth of the tumor (cyst).

Indeed, the symptoms of acute appendicitis may be similar to the symptoms of torsion of the dermoid cyst stalk and vice versa, when suppuration of the dermoid provokes inflammation of the appendix. Otherwise, the clinical picture that accompanies a teratoma of the right ovary and a neoplasm of the same etiology in the left ovary are no different from each other, as is the treatment. The difference consists only in some difficulties in the differential diagnosis of right-sided neoplasms.

Teratoma of the left ovary

Teratoma of the left ovary, according to unspecified statistical data, accounts for 1/3 of all teratogenic ovarian tumors, i.e. it is less common than teratoma of the right ovary. The version of lateral asymmetry of the ovaries in principle, their unevenly distributed functional activity, in particular ovulation, is a subject for constant discussions among specialists. Some gynecologists are convinced that the left ovary is much "lazier" than the right one, ovulation in it occurs 2 times less often, accordingly, the load on it is reduced. Further, as a consequence, there is a lower percentage of development of tumor processes and pathologies in principle. Indeed, the hypothesis that actively acting organs are more vulnerable in terms of the development of neoplasms exists and finds clinical confirmation. However, teratoma of the left ovary is not considered a statistical argument for this theory, since according to the latest observations, the frequency of its development is almost identical to the percentage of tumors of the right ovary. American doctors collected data on germ cell tumors over a five-year period (from 2005 to 2010) and did not find any significant differences in terms of lateral asymmetry.

The symptoms of left-sided ovarian teratoma are similar to the clinical manifestations of a tumor in the right. Signs appear only if the teratoma grows to a large size, if it becomes inflamed, suppurates, or twists the stalk of a mature formation - a dermoid cyst. Also, obvious symptoms may indicate a malignant course of the process, possibly indicating that the woman is already experiencing metastasis.

Ovarian teratoma and pregnancy

Germ cell neoplasms, like many other "silent" benign tumors, are detected by chance - very rarely during preventive medical examinations, since according to statistics only 40-45% of women undergo them. More often, ovarian teratoma is detected when a patient is being diagnosed with a pregnancy or during an exacerbation, inflammation of the tumor, when clinical symptoms become obvious.

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

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

If a woman is diagnosed with both ovarian teratoma and pregnancy, this means only one thing - you need to follow all doctor's recommendations and not try to self-medicate. It is believed that germ cell tumors are not able to affect the hormonal system, rather it can activate the growth of teratoma, including during pregnancy. An enlarged uterus definitely entails dystopia of internal organs, respectively, their displacement can provoke either strangulation of the tumor, but most often among the possible complications there is torsion of the stalk of the dermoid cyst. The danger is ischemic necrosis of tumor tissue, rupture of the cyst. Therefore, a pregnant woman is sometimes shown laparoscopic surgery to remove the teratoma, as a rule, such an action is possible only after the 16th week of pregnancy. Very rarely, the operation is performed urgently, when complications develop - suppuration of the dermoid cyst, torsion of its stalk.

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

If the teratoma is small and does not cause functional disorders, it is observed throughout the gestation process, but is necessarily removed either during childbirth by cesarean section or after normal, natural childbirth after 2-3 months. All types of teratomas are treated only by surgery; it is better to get rid of such a neoplasm and neutralize the risk of tumor malignancy.

Cystic teratoma of the ovary

Cystic germ cell neoplasm, cystic teratoma of the ovary is a dermoid cyst, which is most often diagnosed by chance, characterized by a benign course and a favorable prognosis in 90% of cases. Malignancy of a cystic tumor is possible only when it is combined with malignant neoplasms - seminoma, chorionepithelioma.

Cystic teratoma is usually unilateral, occurring with equal frequency in both the right and left ovary, although there is evidence indicating a more frequent right-sided localization.

Dermoid cyst (cystic mature teratoma) has an oval round shape, a dense capsule structure and various sizes - from the smallest to giant. Most often, the cyst is single-chambered, it includes embryonic tissues of the germ layers - follicles, hair, parts of the nervous system tissue, muscle, bone, cartilage tissue, epithelium of the dermis, intestines, fat.

Clinical features of mature teratoma (cystic teratoma):

• The most common of all tumors of the sex 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 size of a mature teratoma is 5-7 centimeters: small ones are difficult to diagnose using ultrasound, giant ones are extremely rare.
• A mature teratoma is very mobile and does not manifest itself symptomatically, since it has a long stalk.
• Because of its characteristic long pedicle, the dermoid cyst is at risk for torsion and ischemic tissue necrosis.
• Dermoid most often contains ectoderm tissues (teeth particles, cartilage tissue, hair, fat).

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

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Immature ovarian teratoma

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

Immature ovarian teratoma most often develops rapidly, consists of nerve and mesenchymal cells, and is localized in the anterior zone of the uterus. Rapidly growing and metastasizing, the immature tumor transforms into teratoblastoma.

Characteristics of teratoblastoma:

• The frequency of formation is 2-3% of all detected teratogenic tumors.
• The average age of patients is 18-25 years.
• The tumor is most often unilateral.
• The sizes of unripe tertoms range from 5 to 40 centimeters.
• The surface is often smooth and elastic, with solid or cystic structures in cross-section.
• Immature tumors quickly become necrotic and are prone to hemorrhage.
• The tumor composition is specific, more often than in other teratomas, parts of nervous tissue (hyperchromic cells) and fibrillar inclusions are found in it. The inclusion of cartilaginous, epithelial tissue, and ecdodermal elements is not typical for immature teratoma.
• An immature tumor may be accompanied by gliomatosis (glial tumor) or chondromatosis of the abdominal cavity, endometriosis.

The tumor is characterized by rapid development, metastasis occurs through the hematogenous or lymphatic route, forming metastases in nearby and distant internal organs.

Symptoms of immature teratoma are non-specific – weakness, fatigue, possible weight loss. The tumor does not affect the hormonal system and menstrual cycle, accompanied by pain in the already advanced, often terminal stage. Diagnostics should be as differential as possible, since immature ovarian teratoma is often similar to cystoma.

Treatment of an immature tumor is assumed only by means of surgery, which is carried out regardless of the patient's age. After surgical radical removal of the uterus, appendages, omentum, chemotherapy, radiation therapy, and prescription of antitumor drugs are indicated. The process progresses rapidly, the prognosis is extremely unfavorable due to rapid metastasis of the immature teratoma.

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

Mature ovarian teratoma

Mature teratogenic tumor differs from other types of teratoma by the type of chromosomal abnormality, it consists of differentiated, precisely defined derivatives of embryonic cells (germinal layers). Mature ovarian teratoma can be cystic in structure, but can also be single, whole - solid.

1. Mature solid teratoma is a mostly benign tumor of varying sizes. The structure of a solid teratoma consists of cartilaginous, bone, sebaceous elements and is characterized by high density, but is not uniform - it contains very small cystic vesicles filled with transparent mucus
2. Cystic mature teratoma (dermoid cyst) is a large tumor consisting of one or more cystic neoplasms. The cyst contains gray-yellow mucus, cells of the sebaceous and sweat glands, muscle tissue, between the cysts there are denser cells of bone, cartilage tissue, rudimentary particles of teeth and hair. In terms of microscopic structure, cystic mature tumors are not very different from solid teratomas, in these types characteristic organoid cells are found. However, mature ovarian teratoma of cystic structure has a more 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 torsion of the pedicle due to its length and the typical large size of the cyst itself. Treatment of dermoid cysts is only surgical, it is indicated at any age of patients and even during pregnancy under certain indications - size more than 5 centimeters, risk of cyst rupture, torsion of the stalk, inflammation or suppuration.

Diagnosis of teratoma

Teratogenic tumors are often diagnosed as a result of spontaneous examinations, usually for another disease or during pregnancy registration. Teratoma diagnostics are described in various sources, but many sources tend to repeat unspecified information. This is due to insufficient study of teratoma in principle, its unspecified etiology. In addition, the symptoms of teratomas are not obvious, it is no coincidence that these neoplasms are called "silent tumors".

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

• Bimanual examination of the vagina is a classic diagnostic method.
• Examination using gynecological speculums.
• Ultrasound examination of the neoplasm and nearby organs Ultrasound can be performed as a screening of intrauterine pathology of the fetus for early detection of neoplasms. Ultrasound is performed using a vaginal or abdominal sensor.
• X-ray examination, including of organs in which metastasis is possible.
• Dopplerography.
• Computed tomography (CT) as a clarifying measure after ultrasound and X-ray.
• Puncture of the abdominal cavity under ultrasound control for cytology.
• Biopsy, histology.
• Irrigoscopy and rectoscopy are possible.
• Determination of tumor markers in the blood (the presence of human chorionic gonadotropin, alpha-fetoprotein), placental antigens.
• Chromocystoscopy for staging malignant tumors.

Diagnostics of ovarian teratoma, a set of measures is a whole strategy, which is compiled on the basis of the primary clinical picture, most often non-specific. The above list of methods and procedures is usually used with pronounced symptoms, characteristic of teratomas complicated by inflammation, or for its malignant types. Clarification of the diagnosis is the data of histological studies (biopsy).

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Treatment of ovarian teratoma

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

• Stage of the tumor process.
• Teratoma size.
• Patient's age.
• Concomitant diseases and immune status.
• Sensitivity of malignant teratoma to radiation therapy, chemotherapy.

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

1. Mature teratoma, which is one of the most favorable in terms of prognosis type of germ cell tumors, dermoid cyst is treated only by surgery. The earlier the tumor is removed, the lower the risk of potential danger of developing into an oncological process. As a rule, enucleation is used using laparoscopy, that is, the tumor is removed within the visually determined boundaries of healthy tissue. Partial resection of the ovary affected by the tumor is also possible, such operations are performed in young women, girls to preserve reproductive function. For women in the premenopausal period or during menopause, radical removal of the uterus, appendages is performed to reduce the risk of teratoma degeneration into cancer. The vast majority of operations are successful, the prognosis is favorable. Additional treatment is possible only for faster restoration 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, radical surgery is indicated
2. Malignant types of teratomas - immature tumor, teratoblastoma are treated in a complex way, both surgically and with the help of chemotherapy, radiation. Chemotherapy involves at least 6 courses, using platinum drugs (cisplatin, platidiam, platinol). Radiation can be relatively effective at the III stage of the oncological process. Also, hormonal therapy can be included in therapeutic measures if the tumor contains receptors sensitive to hormonal drugs. Treatment of ovarian teratoma, defined as malignant, is inevitably complicated by side effects - nausea, vomiting, kidney pain, depressed hematopoiesis (hematopoiesis), baldness, anemia. Despite the fact that many gynecologists believe that teratomas are not sensitive to chemotherapy, nevertheless, all known methods 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, more often the symptoms disappear for a while, and the tumor decreases in size by half. Unfortunately, the prognosis for malignant teratomas is disappointing. Treatment of ovarian teratoma diagnosed as teratoblastoma does not bring results and the mortality rate is very high due to rapid metastasis to vital organs.

Treatment of teratoma symptoms

Like other benign tumors, teratoma is not specific in terms of symptoms, but all types of germ cell neoplasms have one main treatment method in common: surgical removal of the tumor.

Treatment and symptoms of teratoma are a subject for detailed study by geneticists, gynecologists, and surgeons. Today, the only method of neutralizing teratomas is surgery as the most effective method that minimizes the risk of tumor malignancy. As a rule, treatment begins after accidental detection of a neoplasm, less often for urgent indications, when the teratoma becomes inflamed, suppurates, and the classic picture of "acute abdomen" appears with torsion of the dermoid cyst stalk. Malignant teratogenic tumors are also operated, and treatment and symptoms of teratoma can be simultaneous, which is typical for the terminal stage of the oncological process.

Let us list the most common types of teratomas and methods of their treatment:

• Dermoid cyst or mature teratoma (cystic mature teratoma). Dermoids generally develop asymptomatically, they do not manifest themselves with pain and rarely cause functional disorders. However, large cysts can be strangulated due to their proximity to adjacent internal organs, in addition, they are prone to inflammation, the cyst stalk can twist and provoke necrosis of the dermoid tissue. Symptoms of complicated dermoid cysts include transient dysuria (impaired urination), constipation, and periodic pain in the lower abdomen. Torsion of the stalk is typical of the "acute abdomen" picture, in which case the treatment and symptoms of teratoma occur simultaneously, the operation is performed urgently. Dermoids in pregnant women are also subject to removal, small cysts are left until childbirth, after which, after 2-4 months, the teratoma must be removed. Benign teratoma, which becomes inflamed during pregnancy, is operated on according to indications, but most often on a planned basis after the 16th week. The prognosis for treatment is favorable in 95% of all cases, relapses are almost never encountered.
• Immature teratomas, prone to rapid transformation into another type - teratoblastomas, are characterized by the symptoms typical of many malignant processes. Such a teratoma especially clearly signals itself with widespread metastases, usually in the terminal stage. Diagnostics is carried out 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 decay and metastasis of teratoma are similar to other acute somatic pathologies, therefore they are subjected to inadequate therapy that does not bring relief and does not give a result. Just like a benign mature teratoma, an immature tumor is operated on, the entire uterus and appendages are amputated, the omentum is removed. Then the malignant process is subjected to radiation therapy, chemotherapy. The prognosis for the treatment of malignant teratomas is unfavorable due to the rapid development of the tumor, but to a greater extent due to its late diagnosis and the advanced stage of the process.

Removal of ovarian teratoma

Removal of benign neoplasms is considered a method that helps to minimize the risk of malignancy of such tumors. Removal of ovarian teratoma surgical intervention can be performed in various volumes and approaches, depending on the size of the tumor, concomitant genital diseases, the age of the patient, the presence or absence of extragenital pathology.

Women of childbearing age undergo partial resection (cystectomy), preserving ovarian tissue as much as possible. The operation is performed laparoscopically using a special device - an evacuation bag. Women in perimenopausal age (menopause) are shown supravaginal removal of the uterus, both appendages and omentum, such a large-scale operation solves the problem of prevention and reducing the risk of malignancy of teratoma. The prognosis after removal of a benign neoplasm is often favorable, relapses are extremely rare and indicate either an inaccurate species diagnosis of the germ cell formation, or an incomplete removal of the tumor.

Immature teratomas are also removed, but more often using laparotomy, when both the tumor and the affected nearby tissues (lymph nodes) are removed, and possibly metastases visible during the procedure.

In general, endoscopic removal of ovarian teratoma is considered the gold standard in gynecology and surgery. Previously, when benign ovarian tumors were detected, operations were performed only as laparotomy, which damaged the ovary, which often lost its functionality, and was often removed along with the teratoma. The use of high-frequency endoscopic instruments allows a woman to preserve her reproductive function, since the surgical intervention is carried out in the most gentle way.

How is ovarian teratoma removed?

1. After the preparatory procedures are completed, a small incision is made in the abdominal area.
2. During the operation, the doctor conducts an inspection and examination of the abdominal cavity for possible malignant tumor development or bilateral teratoma development (occurs in 20-25% of patients with teratomas).
3. During tumor removal, material is taken for histological examination.
4. After removing the teratoma, the surgeon washes (sanitizes) the inside of the peritoneum.
5. An intradermal suture is placed on the trocar incision using absorbable threads.
6. A day after the teratoma was removed, the patient can get out of bed and walk independently.
7. The stitches are removed on the 3rd-5th day, before discharge.

The operation to remove the teratoma lasts no more than an hour and is performed under general anesthesia. After the operation, it is necessary to follow a gentle 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 popular, more than 90% of all operations in the world for gynecological pathologies are performed using laparoscopy. Laparoscopic surgery is a manipulation performed without dissection of the peritoneum, such a procedure is often called "bloodless". During laparoscopic intervention, large open wounds, many postoperative complications inherent in extensive laparotomy operations are excluded.

Laparoscopy can be a diagnostic or purely therapeutic procedure performed on the abdominal and pelvic organs. The surgical intervention occurs through small trocar punctures through which an optical instrument, a laparoscope, is passed.

Laparoscopy of ovarian teratoma is also considered the “gold standard” in surgery, since it allows preserving the patient’s reproductive function and simultaneously effectively neutralizing tumor formations.

Endoscopic surgery for ovarian teratoma is performed using the same technology as laparoscopy for other gynecological pathologies. Although the removal of a large teratogenic cyst may result in the capsule being opened (perforated) and the contents spilling into the cavity, this does not cause serious complications such as profuse bleeding. The integrity of the ovary is restored after the teratoma is enucleated, usually using bipolar coagulation (“welding”), and no additional sutures are required. Sutures are placed on the ovary as a forming frame only for large tumors (more than 12-15 centimeters).

Laparoscopy of ovarian teratoma can be quite extensive when surgical revision reveals that teratomas are spread in multiples or there is no healthy tissue around the tumor. In such cases, even young women are recommended to undergo oophorectomy (removal of the ovary) or adnexectomy (removal of the ovary and fallopian tube).

What tests should be taken before laparoscopy of teratoma?

• OAC – complete blood count.
• Biochemical blood test.
• Blood clotting test (coagulogram).
• Determination of the Rh factor and blood group.
• Analysis for hepatitis, HIV, sexually transmitted diseases.
• General vaginal smear.
• Electrocardiogram.
• Recommendations from related specialists in the presence of pathologies associated with teratoma.

What kind of pain relief is provided for laparoscopic surgery?

Laparoscopy uses endotracheal anesthesia, anesthesia that is considered one of the most effective and safe. In addition, it is simply impossible to use another type of anesthesia during laparoscopy, since the procedure involves the introduction of a special gas into the abdominal cavity, which does not allow the lungs to breathe independently at full strength. Endotracheal anesthesia provides compensatory breathing throughout the operation.

Laparoscopy of ovarian teratoma, advantages:

• The absence of postoperative pain, typical for extensive abdominal surgeries, means there is no need to use strong analgesics.
• Absence of profuse bleeding.
• Low trauma for soft tissues, fascia, muscles, etc.
• Possibility of additional clarifying diagnostics during optical examination of the cavity (including concomitant pathology).
• Possibility of simultaneously operating on combined pathology identified during the procedure.
• Reducing the risk of adhesions, since contact with the intestines is minimal, and accordingly the risk of developing infertility due to adhesions is neutralized.
• There is no cosmetic defect, since the trocar punctures heal quickly and are practically invisible.
• There is no need for a long hospital stay.
• On the second day after laparoscopic surgery, patients can get up and move around independently.
• Rapid restoration of general normal well-being and return of working capacity.