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Background and Aims: Benign ovarian neoplasms are common in the pediatric population. In young adult women, oophorectomy has been shown to negatively impact long-term ovarian endocrine function. Recently, ovarian-sparing surgery (OSS) has been proposed as it offers similar results to oophorectomy in terms of recurrence rates. However, the impact of OSS on functional preservation in girls and adolescents remains unclear due to limited follow-up data. The aim of this study was to evaluate ovarian function and its morphological correlation in the medium term in girls undergoing OSS for benign neoplasms., Methods: A retrospective cohort study was conducted including girls under 15 years of age who underwent OSS for benign neoplasms at our hospital between January 2014 and July 2022. Eligible patients were cited to an on-site evaluation at least 12 months after surgery. Data collected included age at surgery, tumor volume, history of adnexal torsion and recurrence. Postoperative ovarian volume was assessed by transabdominal pelvic ultrasound, and serum anti-Müllerian hormone (AMH) levels were measured and compared to expected values for age., Results: Thirty-seven patients presented with 39 ovarian neoplasms; 31 underwent OSS. Mean age at surgery was 11.7 years, and mean period from surgery to face-to-face evaluation was 46.6 months. Excluding cases with ovarian torsion, normal ovarian volume (>-2 standard deviations (SD) from the expected value for age) was observed in 22/27 ovaries (81.5 %). In patients with normal volume ovaries after unilateral disease, 17/19 (89.5 %) AMH values were > -1SD from the expected value. A positive and statistically significant correlation was found between postoperative ovarian volume and AMH levels (Pearson correlation 0.52, p < 0.01). One patient who underwent oophorectomy and one who underwent OSS reported achieving pregnancy without medical intervention. No ipsilateral recurrences were observed during the follow-up period., Conclusions: OSS is a viable alternative for treating benign neoplasms in girls, showing morphological and functional results comparable to healthy women from one-year post-intervention onwards. Long-term follow-up and prospective studies are needed to determine the effectiveness of OSS in maximizing fertility and avoiding premature menopause, which occurs after oophorectomy at an early age, while maintaining similar oncological outcomes., Level of Evidence: IV., (Copyright © 2024 Elsevier Inc. All rights reserved.)

This study evaluated the safety and efficacy of spinal anesthesia as an alternative to general anesthesia in single-port access (SPA) laparoscopic adnexal surgeries. 110 patients were recruited and, after propensity score matching, 63 (general anesthesia: 42, spinal anesthesia: 21) were analyzed. During surgery, the Trendelenburg position was limited to 15°, and CO2 pressure maintained at 8-12 mmHg. Postoperative pain and nausea/vomiting scores were assessed up to 48 h post-surgery. No significant differences in patient characteristics were noted between groups. Immediately postoperative, the spinal anesthesia group showed significantly lower pain scores (4.74 ± 1.48 in spinal anesthesia vs. 0.67 ± 0.66 in general anesthesia; p <.001) and nausea/vomiting scores (p =.027). Intraoperative hypotension occurred in both groups (28.6% in spinal anesthesia vs. 33.3% in general anesthesia; p =.774) and was managed with ephedrine. No other intraoperative or postoperative complications were noted. Conclusively, spinal anesthesia is a viable and safe option for SPA laparoscopic salpingo-oophorectomy, effectively reducing immediate postoperative pain and nausea/vomiting., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Institutional Review Board of Yonsei University Wonju Severance Christian Hospital (approval code C318120). Patient consent was waived due to the retrospective nature of the study, where only pre-existing data was used. This study was conducted in accordance with the principles of the Declaration of Helsinki. Consent for publication: N/A. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Mice (Mus musculus) are one of the most commonly used animal species in basic science and translational research worldwide. Ovariectomy and hysterectomy are frequently employed to explore the systemic effects of the sex-hormone axis and other pathological conditions. While several surgical protocols exist for dorsal ovariectomy in rodents, very few address a ventral midline technique, and none are specific to the mouse model. Historically, ventral midline approaches have been considered technically challenging due to unique anatomical features, including long, thin uterine horns, fragile salpinges, short ovarian suspensory ligaments, and small animal size. This protocol provides a detailed guide for performing ovariectomy, hysterectomy, or ovariohysterectomy in mice, including the microsurgical steps required. All procedures were performed using an operative stereomicroscope under 3-5x magnification. The mean weight of the mice was 24 g (SD = 2 g), with ages ranging from 19 to 21 weeks. Of the 255 surgeries performed, 3 post-operative deaths occurred, resulting in an attrition rate of 1.18%. Post-operatively, all mice were housed in groups with fresh, paddy husk bedding, and no infections or wound breakdown were observed. Despite their small size and the manipulation of several vital anatomical structures, this procedure is easily reproducible and well-tolerated in mice., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Approaches to paediatric ovarian tumours vary. Cross-sectional imaging is reliable but not always performed. Laparoscopic tumourectomy, although popular, is not recommended by International Paediatric Surgical Oncology Society (IPSO); tumour spillage remains the main concern. We aimed to investigate the reliability of preoperative evaluation and identify perioperative factors associated with adverse outcomes., Methods: Single-centre retrospective study (2015-2022) of clinical presentation, preoperative investigation, operative approaches and oncological outcomes in all females <18 years treated for ovarian tumours. Logistic regression was used to identify predictors of malignancy and of second disease events. Data are presented as median (IQR) or rates., Results: Sixty girls aged 12.5 (10-15) years with follow-up of 51 (30.5-76.3) months were included. Incidence of malignant and low malignant potential tumours was 19/60 (32%). Tumour size and consistency proved predictive of malignancy. Clinical assessement, tumour markers and cross-sectional imaging combined showed 75% sensitivity, 100% specificity and 7% misclassified malignancy rate. Second disease events (11/60, 18%) were associated with misclassified malignancy (2/11 vs. 1/49, p = 0.04) and positive margins (4/11 vs. 5/49, p = 0.02). Ovarian-sparing surgery did not influence second events (5/11 vs. 28/49, p = 0.48). There was no significant association between second events and laparoscopic tumourectomy (3/11 vs. 20/49, p = 0.40); spillage rate was however more frequent with laparoscopy (5/11 vs. 2/32, p = 0.008)., Conclusion: Misclassified malignancy, noted in 7% of patients undergoing optimal work-up, adversely impacted outcomes, highlighting the importance of oncological principles in both oophorectomy and ovarian-sparing surgery. Malignancy incidence and misclassification can be underestimated when tumours with malignant behaviour potential, such as immature teratomas and borderline tumours, are grouped as benign. There was no direct association between operative approaches and second events. Laparoscopy, however, failed to maintain oncological principles more frequently than open surgery and hence risks upstaging of paediatric ovarian pathology., Level of Evidence: III., Competing Interests: Conflict of interest The authors have no competing interests to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Primary leiomyoma is one of the rarest benign ovarian tumors. Since the first case was identified, less than 100 cases have been reported worldwide. This study aimed to analyze the clinical characteristics and discuss the proper management of this tumor. A review of the patients' medical records was undertaken from January 2015 to December 2023. A total of 21 cases of primary ovarian leiomyoma and 5 cases of inherent ligament leiomyoma were identified. The mean age was 45.6 years (17-67 years). The tumor size ranged from 1.2 to 7.0 cm (mean, 3.7 cm) by ultrasound. Eighteen (69.2%) patients complained of an asymptomatic pelvic mass. None of them was successfully diagnosed before the surgery. Twelve patients underwent laparoscopic salpingo-oophorectomy or oophorectomy with a mean diameter of 2.9 cm and an average age of 54.2 years. Meanwhile, 12 patients underwent laparoscopic tumorectomy with a mean diameter of 3.0 cm and an average age of 39.3 years. Besides, two patients underwent laparotomic tumorectomy. After a mean follow-up of 35.7 months, patients were alive with no disease recurrence. In conclusion, tumorectomy is preferred for patients with conception requirement or at reproductive age. Laparoscopic surgery is considered as an effective and safe approach., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objective: To compare the effectiveness of endometriosis excision alone to excision plus hysterectomy, with and without bilateral oophorectomy, for endometriosis-related symptoms., Design: Multicentre prospective cohort., Setting: Eighty-six specialist endometriosis centres., Population: Women undergoing rectovaginal endometriosis surgery between 2009 and 2021., Methods: We performed multivariable regression with random effects for patient and centre, controlling for age, BMI, smoking, laparoscopic versus open approach and type of bowel surgery performed, with sensitivity analysis for loss to follow-up., Main Outcome Measures: Pain scores, bowel symptoms and quality-of-life measures., Results: Compared to endometriosis excision alone, women undergoing hysterectomy with conservation of ovaries had greater improvement in non-cyclical pain (MD: 1.41/10, 95% CI: 1.03-1.78, p < 0.001), dyspareunia (MD: 1.12/10, 95% CI: 0.71-1.53, p < 0.001), back pain (MD: 1.29/10, 95% CI: 0.92-1.67, p < 0.001) and quality-of-life scores (MD: 8.77/100, 95% CI: 5.79-11.75, p < 0.001) at 24 months post-operatively. Women undergoing hysterectomy with bilateral oophorectomy also had greater improvement in non-cyclical pelvic pain (MD: 2.22/10, 95% CI: 1.80-2.63, p < 0.001), dyspareunia (MD: 1.05/10, 95% CI: 0.59-1.52, p < 0.001), back pain (MD: 1.18/10, 95% CI: 0.77-1.59, p < 0.001) and quality of life (MD: 12.41/100, 95% CI: 9.07-15.74, p < 0.001) at 24 months compared to endometriosis excision alone. Compared to hysterectomy with ovarian conservation, hysterectomy with bilateral oophorectomy was associated with greater improvement in non-cyclical pelvic pain (MD: 0.81/10, 95% CI: 0.32-1.30, p = 0.001) at 24 months and quality of life (MD: 3.74/100, 95% CI: 0.56-6.92, p = 0.021) at 12 months, although this result was sensitive to loss to follow-up., Conclusions: Patients who undergo endometriosis excision plus hysterectomy experience greater improvement in pain and quality of life compared to those who have endometriosis excision alone. There are additional benefits of bilateral oophorectomy with hysterectomy, although its value is less clear due to loss of follow-up., (© 2024 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Objective: The objective of this study is to compare intraoperative and postoperative outcomes in women undergoing removal of adnexal structures by either posterior culdotomy or abdominal extraction., Design: This is a retrospective cohort study conducted via medical record review. Demographic, clinical, and operative variables were abstracted from the medical records. Statistical analysis consisted of descriptive statistics, Fisher's exact tests, Wilcoxon rank sum tests, and multivariable logistic regression models., Setting: Single academic tertiary care center between 2010 and 2022., Participants: A total of 718 patients were identified and included in our analysis who underwent minimally invasive ovarian cystectomy or oophorectomy. Patients were excluded if they underwent concomitant hysterectomy., Interventions: Patients underwent minimally invasive oophorectomy or ovarian cystectomy, and specimens were extracted by either abdominal extraction (AE) or culdotomy extraction (CE)., Measurements and Main Results: Of the 718 patients who met inclusion criteria, 127 (17.7%) underwent CE, and 591 (82.3%) underwent abdominal extraction. The CE group had longer operative times (113 minutes vs 96 minutes, p <.001) and higher estimated blood loss (25 mL vs 10 mL, p <.001) compared to the abdominal extraction group. There were more malignancies in the CE than the abdominal extraction group (15.7% vs 8.1%, respectively, p <.001). After adjusting for potential confounders, those who underwent CE were more likely to have 2 or more clinic visits (OR 2.89; 95% confidence interval, 1.66-5.03; p <.001) and call or message the clinic (OR 2.08; 95% confidence interval, 1.35-3.20; p <.001). There were no incidences of cuff dehiscence, cuff cellulitis, or pelvic abscess in either group., Conclusion: Removal of adnexal specimens via abdominal port site or posterior culdotomy incision is a feasible option for specimen extraction and can be individualized based on patient and surgeon preference and patient factors. Those undergoing CE may require more preoperative counseling due to higher rate of postoperative messages seen in our cohort., (Copyright © 2024 AAGL. Published by Elsevier Inc. All rights reserved.)

Epithelial ovarian cancer (EOC) is the most lethal type of gynaecological cancer, due to lack of effective screening possibilities and because the disease tends to metastasize before onset of symptoms. Women with an increased inherited risk for EOC are advised to undergo a risk-reducing salpingo-oophorectomy (RRSO), which decreases their EOC risk by 96% when performed within guideline ages. However, it also induces premature menopause, which has harmful consequences. There is compelling evidence that the majority of EOCs originate in the fallopian tube. Therefore, a risk-reducing salpingectomy with delayed oophorectomy (RRS with DO) has gained interest as an alternative strategy. Previous studies have shown that this alternative strategy has a positive effect on menopause-related quality of life and sexual health when compared to the standard RRSO. It is hypothesized that the alternative strategy is non-inferior to the standard RRSO with respect to oncological safety (EOC incidence). Three prospective studies are currently including patients to compare the safety and/or quality of life of the two distinct strategies. In this article we discuss the background, opportunities, and challenges of the current and alternative strategy., (© 2024. The Author(s).)

Background: Benign ovarian lesions in the pediatric population have variable risk of recurrence or development of metachronous lesions, leading to variations in operative approach. Our study compares outcomes with differing surgical approaches to better elucidate risk of recurrent or metachronous lesions, time to development of these lesions, and hospital length of stay to determine if one operative approach has superior outcomes. Methods: We retrospectively examined data from Indiana University Health facilities from 2002 to 2020. Patients ≤18 years old who underwent surgical management of a benign ovarian lesion were included. Patients were categorized as undergoing oophorectomy versus ovarian sparing surgery (OSS), with open and laparoscopic approaches. Significance was defined as P < .05. Results: We identified 127 patients who underwent an open ( n = 65) versus laparoscopic ( n = 55) surgical approach. Patients undergoing open surgery had a greater mean size of lesion ( P = .05) and longer length of stay ( P < .01). Complication rates ( P = .1), rates of developing a metachronous or recurrent lesion postoperatively ( P = .47), and time to formation of additional lesions were similar between groups ( P = .25). The incidence of identifying an additional lesion after surgery was 14.2% ( n = 18) in the mean time of 29.5 ± 31.6 months [SEM 7.5]. Risk of developing a metachronous lesion was similar regardless of the operative approach. Surgery for recurrent ovarian lesions was rare and occurred in only 1 case. Conclusions: Laparoscopic surgery was performed for smaller lesions and was associated with a shorter length of hospital stay. Laparoscopic and OSS was found to have no increased risk of developing metachronous lesions nor increased reoperative risk compared with traditional open and oophorectomy techniques.

Introduction: In the Emilia-Romagna region of Italy, a unique Hub and Spoke model was adopted to recognize BRCA-related breast cancer (BC) patients. Characteristics and outcomes of tumors identified by this model will be presented., Methods: This multicenter retrospective cohort study involved patients diagnosed with BRCA-related BC identified in the Emilia-Romagna region between January 2000 and December 2013. Seven provinces collected data on patient and tumor characteristics; clinical and gene testing information were also registered. Comparisons between BRCA1 and BRCA2 BC were performed. To balance different variants to identify significant predictors of survival, an inverse probability of treatment weighting (IPTW) analysis on Cox regression was conducted., Results: From 2000 to 2013, 284 BRCA-related BC were registered (171 BRCA1, 110 BRCA2, and 3 BRCA1 and BRCA2). BRCA1 were diagnosed at an earlier stage compared to BRCA2 (50.1 % vs 30 %, respectively, in stage I, P = 0.0015). BRCA2 patients underwent more up-front surgery (85 % vs. 74.9 %, P = 0.049) and less chemotherapy (69.1 % vs 88.9 %, P = 0.004) than BRCA1 patients. At 11.8 years median follow-up, BRCA1 patients developed more second contralateral BC (P = 0.09), while BRCA2 had more visceral relapses (P = 0.013). No differences in overall survival (OS) between BRCA1 and BRCA2 patients (P = 0.07) were found. An advantage in OS was independently seen for patients who underwent contralateral prophylactic mastectomy (P = 0.0001) and oophorectomy (P < 0.0001)., Conclusions: In conclusion, adopting a homogeneous regional framework provides important information about prevention and treatment strategies of BRCA-related BC and suggests using maximal surgery to improve OS., Competing Interests: Declaration of competing interest LC: speaker honoraria from Astra Zeneca, Pfizer, Novartis, Gilead, MSD; advisory role for Astra Zeneca, Pfizer, MSD, Amgen, Roche; GC, MV: no conflict of interest to disclose; AT: speaker honoraria from Lilly, Novartis, Pfizer, AstraZeneca, MSD, Seagen, Gilead, Daiichi Sankyo; EB: travel grants from Lilly, Novartis, Pfizer, MSD, AstraZeneca, Gilead, Daiichi Sankyo; FT: no conflict of interest to disclose; AM: Honoraria: Eli-Lilly, Pfizer, Macrogenics, Seagen, and Daiichi Sankyo; institutional research funding: Roche, Eli-Lilly; UDG: Advisory Board: MSD, Bristol Myers Squibb, Janssen, Astellas, Sanofi, Bayer, Pfizer, Ipsen, Novartis, and Pharmamar. Institutional Research grants: AstraZeneca, Sanofi, and Roche; GB, VA: no conflict of interest to disclose; CZ: Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events by Roche, Eisai, Novartis, Astrazeneca, Pfizer, Pharmamar, Tesaro, Pierre Fabre, Ist. Gentili, Teva, Seagen, Eli Lilly, Celgene, MSD, GSK, Amgen, Daichii, Support for attending meetings and/or travel by Roche, Novartis, Pfizer, Pharmamar, Tesaro, Pierre Fabre, Ist. Gentili, Celgene, Participation on a Data Safety Monitoring Board or Advisory Board by Roche, Eisai, Novartis, Astrazeneca, Pfizer, Pharmamar, Amgen, Tesaro, QuintilesIms, Eli Lilly, Celgene, MSD, GSK, Daichii, Other financial or non-financial interests by Roche, Novartis, Astrazeneca, Pfizer, Amgen, Tesaro, QuintilesIms, MSD, GSK, Daichii. LC, MD: no conflict of interest to disclose., (Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Background: Deep and extensive wounds usually cannot be closed directly by suturing or skin grafting. Flap transplantation is typically used to reconstruct large wounds clinically. The flap survival is based on a stable blood perfusion. It is established that estrogen promotes wound healing and angiogenesis, and regulates the inflammatory response, leading to enhanced flap survival after transplantation. However, estrogen concentrations administered in previous studies were significantly higher than physiological levels, potentially causing systemic side effects. Estrogen-sustained-release silastic capsules can maintain blood serum estrogen closer to physiological levels. This study aimed to investigate whether administering estrogen at a lower concentration, closer to physiological levels, could still enhance flap survival., Materials and Methods: This study was performed in a random skin flap model in ovariectomized (OVX) mice. Sustained-release estrogen silastic capsules were implanted into OVX mice to determine the functional role of estrogen in wound healing after flap transplantation. Flap blood perfusion was analysed using a colour laser Doppler scanner. Immunohistochemical staining of CD31, hypoxia-inducible factor 1 alpha (HIF-1α), alpha-smooth muscle actin (α-SMA), cleaved caspase 3 and apoptotic terminal dUTP nick end-labelling stain was used to investigate flap angiogenesis, tissue hypoxia, wound healing and cell death in the flap tissue, respectively., Results: We observed that administering estrogen at a lower concentration enhanced superficial blood perfusion while reducing the flap's ischemic area and tissue necrosis. HIF-1α expression was significantly decreased in the dermis layer but not in the fascia, whereas cleaved caspase 3 levels decreased in the fascia but remained unchanged in the dermis. Additionally, there was no significant difference in CD31and α-SMA expression between the groups., Conclusion: In summary, the study showed that an estrogen silastic capsule maintained physiological estrogen levels and improved superficial perfusion, thereby reducing dermal hypoxia, and cell death in a mouse random pattern skin flap model. Although no significant promotion of angiogenesis was observed, the study suggests that appropriate estrogen supplements could enhance flap wound recovery., (© 2024 The Author(s). International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Background: Postmenopausal osteoporosis (PMO) is a chronic condition characterized by decreased bone strength. This study aims to investigate the effects and mechanisms of the combination of Butyricicoccus pullicaecorum (Bp) and 3-hydroxyanthranilic acid (3-HAA) on PMO., Methods: The effects of Bp and 3-HAA on PMO were evaluated in ovariectomized (OVX) rats by assessing stereological parameters, femur microstructure, and autophagy levels. The T helper (Th) 17/Regulatory T (Treg) cells of rats were detected using flow cytometric analysis. Furthermore, the impact of Bp and 3-HAA on the gut microbiota of rats was assessed using 16S rRNA gene sequencing. The correlation between the gut microbiota of rats and Th17/Treg immune factors, as well as femoral stereo parameters, was separately assessed using Spearman rank correlation analysis., Results: Bp and 3-HAA treatments protected OVX rats by promoting osteogenesis and inhibiting autophagy. Compared to the Sham group, OVX rats showed an increase in Th17 cells and a decrease in Treg cells. Bp and 3-HAA reversed these changes. Enterorhabdus and Pseudomonas were significantly enriched in OVX rats. Bp and 3-HAA regulated the gut microbiota of OVX rats, enriching pathways related to nutrient metabolism and immune function. There was a correlation between the gut microbiota and the Th17/Treg, as well as femoral stereo parameters. The concurrent administration of Bp and 3-HAA medication facilitated the enrichment of gut microbiota associated with the improvement of PMO., Conclusion: The combination therapy of Bp and 3-HAA can prevent PMO by modulating the gut microbiota and restoring Th17/Treg immune homeostasis., (© 2024. The Author(s).)

Purpose: The management of ovarian torsion in pediatric patients has evolved over time. Ovarian salvage is currently recommended given concerns for fertility preservation and the low likelihood of malignancy. Studies have shown that the incidence of oophorectomy is higher amongst pediatric surgeons in comparison to gynecologists. Using a national database, this study examined how the surgical management of ovarian torsion has evolved., Methods: Children with a discharge diagnosis of ovarian torsion (ICD-9 code 620.5, ICD-10 code N835X) and procedure codes for oophorectomy (CCS code 119) were identified within the KID database from 2003, 2006, 2009, 2012, 2016, and 2019. Diagnosis of ovarian pathology was based upon ICD-9 and ICD-10 codes at the time of discharge., Results: A total of 7008 patients, ages 1-20, had a discharge diagnosis of ovarian torsion. Of those patients, 2,597 (37.1%) were diagnosed with an ovarian cyst, 1560 (22.2%) were diagnosed with a benign ovarian neoplasm, and 30 (0.4%) were diagnosed with a malignant neoplasm. There was a decreased risk of oophorectomy in urban-teaching versus rural hospitals (OR: 0.64, p < 0.001). The rate of oophorectomy has decreased overtime. However, patients with benign or malignant neoplasms were more likely to undergo oophorectomy than those without a diagnosis (OR: 2.03, p < 0.001; 4.82, p < 0.001)., Conclusion: The rate of oophorectomy amongst children with ovarian torsion has decreased over time. Yet, despite improvements, oophorectomy is common amongst patients with benign ovarian neoplasms and those treated at rural hospitals. Continued education is needed to optimize patient care in all clinical scenarios., Level of Evidence: IV., (© 2024. The Author(s).)

Objectives: To investigate the oncological safety and fertility outcomes of different fertility-sparing surgery procedures for bilateral borderline ovarian tumors (BOTs) and to identify the safest and most effective approach to help patients conceive with minimal risk., Study Design: A retrospective study of 144 patients (≤40 years) with pathologically confirmed bilateral BOTs were included in the study.The effects of surgery type on fertility outcome and recurrence were compared. Cox regression analysis was employed to determine potential prognostic factors. Survival analysis utilized the Kaplan-Meier method., Results: Three therapeutic modalities were applied in our study, including bilateral ovarian cystectomy (BOC; n = 29), unilateral adnexectomy + contralateral cystectomy (UAC; n = 4) and radical surgery (n = 61). Totally 33 cases (22.9 %) relapsed during the follow-up period. In 37 % of cases administered conservative surgery, relapses were diagnosed in the first 2 years. Only conservative surgery and adjuvant chemotherapy were risk factors for recurrence. Meanwhile, a pregnancy rate of 55.4 % was obtained in patients with bilateral BOTs. The pregnancy rate was slightly higher but no significant (P = 0.539) difference in patients treated with BOC (n = 17, 63 %) compared with UAC (n = 29, 55.8 %) group. GnRHa treatment significantly improved the clinical pregnancy rate in this study(P = 0.029)., Conclusions: Satisfactory pregnancy rate can be achieved after conservative surgery in patients with bilateral BOTs. BOC is worth recommending for bilateral borderline ovarian tumors and a critical factor in fertility is the preservation of maximum healthy ovarian tissue. Patients should make a pregnancy plan in 2 years after the first surgery. GnRHa increase the rate of successful clinical pregnancies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Ovarian cancer remains the most lethal gynaecological malignancy with 314 000 cases and 207 000 deaths annually worldwide. Ovarian cancer cases and deaths are predicted to increase in Australia by 42% and 55% respectively by 2040. Earlier detection and significant downstaging of ovarian cancer have been demonstrated with multimodal screening in the largest randomised controlled trial of ovarian cancer screening in women at average population risk. However, none of the randomised trials have demonstrated a mortality benefit. Therefore, ovarian cancer screening is not currently recommended in women at average population risk. More frequent surveillance for ovarian cancer every three to four months in women at high risk has shown good performance characteristics and significant downstaging, but there is no available information on a survival benefit. Population testing offers an emerging novel strategy to identify women at high risk who can benefit from ovarian cancer prevention. Novel multicancer early detection biomarker, longitudinal multiple marker strategies, and new biomarkers are being investigated and evaluated for ovarian cancer screening. Risk-reducing salpingo-oophorectomy (RRSO) decreases ovarian cancer incidence and mortality and is recommended for women at over a 4-5% lifetime risk of ovarian cancer. Pre-menopausal women without contraindications to hormone replacement therapy (HRT) undergoing RRSO should be offered HRT until 51 years of age to minimise the detrimental consequences of premature menopause. Currently risk-reducing early salpingectomy and delayed oophorectomy (RRESDO) should only be offered to women at increased risk of ovarian cancer within the context of a research trial. Pre-menopausal early salpingectomy is associated with fewer menopausal symptoms and better sexual function than bilateral salpingo-oophorectomy. A Sectioning and Extensively Examining the Fimbria (SEE-FIM) protocol should be used for histopathological assessment in women at high risk of ovarian cancer who are undergoing surgical prevention. Opportunistic salpingectomy may be offered at routine gynaecological surgery to all women who have completed their family. Long term prospective opportunistic salpingectomy studies are needed to determine the effect size of ovarian cancer risk reduction and the impact on menopause., (© 2024 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.)

Objectives: The aim of this study was to compare the analgesic efficacy and the effect on physiological variables and behavior of the use of tramadol, methadone and morphine as preoperative analgesia in healthy cats undergoing elective ovariohysterectomy., Methods: Cats undergoing ovariohysterectomy were randomly assigned to receive one of the following premedication treatments intramuscularly: methadone (0.2 mg/kg; n = 10); morphine (0.2 mg/kg; n = 10); or tramadol (3 mg/kg; n = 10). Induction of anesthesia was done with propofol, and maintenance of anesthesia was done with isoflurane. Intraoperative heart rate, arterial blood pressure, respiratory rate, end-tidal isoflurane concentration and frequency of rescue analgesia (fentanyl 2.5 µg/kg) were compared between groups. Postoperative analgesia was assessed using the UNESP-Botucatu Multidimensional Composite Pain Scale, and perioperative serum glucose, cortisol concentrations and postoperative rescue analgesia were evaluated., Results: Intraoperative rescue analgesia was required in 76.5% of cats at some time during surgery, and 27% of cats required postoperative rescue analgesia up to 6 h after extubation. There were no significant differences between groups with respect to intraoperative and postoperative rescue analgesia, pain scale scores and end-tidal isoflurane concentrations. In the immediate postoperative period, after extubation, most of the patients presented with hypothermia; however, 1-6 h postoperatively, hyperthermia was observed in most of the patients, and was most common in the tramadol group., Conclusions and Clinical Relevance: Under the conditions of this study, methadone, morphine and tramadol produced satisfactory postoperative analgesia in most of the cats undergoing ovariohysterectomy, and the effects lasted up to 6 h postoperatively. Intraoperative analgesia was not sufficient in most cases. Significant cardiovascular or respiratory effects contraindicating the use of these drugs were not found. Postanesthetic hyperthermia occurred with all opioids studied and was more frequent in the tramadol group., Competing Interests: Conflict of interestThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To describe a standing hand-assisted laparoscopic ovariohysterectomy in a mare., Animal: A 15-year-old maiden Oldenburg mare., Clinical Presentation, Progression, and Procedures: The mare was presented for evaluation of bucking under saddle and uncharacteristic aggressive behavior. Evaluation of a 24-hour video of the mare in a stall showed behavior consistent with caudal visceral abdominal discomfort. Reproductive evaluation revealed a pyometra secondary to complete transluminal cervical adhesions. The mare was initially managed medically with disruption of the adhesions and uterine lavage, but the adhesions reformed within 6 weeks and could not be manually disrupted., Treatment and Outcome: To eliminate the recurrence of pyometra, the mare underwent standing hand-assisted laparoscopic ovariohysterectomy through bilateral flank incisions. The only complication was a seroma at 1 flank incision that resolved after drainage., Clinical Relevance: Complete ovariohysterectomy in the mare is a challenging procedure and has previously been performed under general anesthesia. This is the first report of the procedure being performed completely in the standing mare without inversion of the uterus through the cervix.

Background: Abnormalities of the ovary are frequently seen on ultrasound examination, sometimes symptomatic, but are more commonly asymptomatic., Purpose: Presentation of the most important entities of ovarian masses and their imaging features in infants and children. Discussion of criteria for differentiation between benign and potentially malignant masses., Materials and Methods: Review of current literature and presentation of image examples., Results: The most common lesions are ovarian cysts in infants, which usually do not require therapy. Because of the risk of torsion, surgery should be discussed for lesions with a size of 5 cm or more. Benign teratomas represent three-quarters of all solid tumors of the infantile ovary. Malignant masses are rare. The task of imaging is to assess the potential risk of malignancy, also using imaging scores., Conclusions: Imaging plays a crucial role for therapeutic considerations. Depending on the potential risk, ovarian-sparing surgery is preferred to preserve fertility, as long as the oncologic risk is reasonable., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Introduction: Ovarian metastasis of colorectal cancer is known to have a poor prognosis. This study aimed to elucidate the characteristics of patients who underwent oophorectomy for ovarian metastasis from colorectal cancer., Methods: This retrospective study included 16 patients who underwent oophorectomy for colorectal cancer metastasis to the ovary from January 2004 to December 2017. Improvement in patient's symptoms and pre- and postoperative changes in various nutritional and inflammatory indicators were assessed. Survival analysis and identification of prognostic factors were conducted with a median follow-up of 40.7 (5-109) months., Results: Of 16 patients, 12 had (75%) synchronous and 4 (25%) had metachronous metastasis. Fourteen patients were symptomatic but symptoms resolved postoperatively. Thirteen patients (81.3%) had ascites and 5 (31.3%) had pleural effusion on preoperative computed tomography that disappeared after surgery in all cases. The median value of prognostic nutritional factor was significantly increased postoperatively (36.0 [preoperatively] vs. 47.5, p &lt; 0.0001). The median (interquartile range) values for lymphocyte-C-reactive protein ratio were 715.2 (110-2,607) preoperatively and 6,095.2 (1,612.3-14,431.8) postoperatively (p = 0.0214). The median survival of the entire cohort was 60.4 months. The 3-year survival rates for R0 + R1 and R2 cases were 83% and 24% (p = 0.018), respectively. Univariate analysis showed that R2 resection and low postoperative lymphocyte-C-reactive protein ratio were associated with poor prognosis., Conclusions: Oophorectomy for ovarian metastasis from colorectal cancers was safely performed. It improved the patients' symptoms and nutritional status and may result in improved prognosis., (© 2023 S. Karger AG, Basel.)

Background: Up to 40% of patients aged ≤55 years undergo concomitant bilateral salpingo-oophorectomy at the time of benign hysterectomy, with practice variation in bilateral salpingo-oophorectomy occurring along the lines of patient health and social factors. Disability is common in premenopausal women and is an important determinant of reproductive health more broadly; however, studies on bilateral salpingo-oophorectomy rates among women with disabilities are lacking., Objective: This study aimed to examine whether the use of concomitant bilateral salpingo-oophorectomy at the time of benign hysterectomy differs by preexisting disability status in adult females aged ≤55 years., Study Design: This population-based cross-sectional study used data from the 2016-2019 US National Inpatient Sample. Females undergoing inpatient hysterectomy for a benign gynecologic indication (n=74,315) were classified as having physical (6.1%), sensory (0.1%), intellectual or developmental (0.2%), or multiple (0.2%) disabilities and compared with those without a disability. Logistic regression was used to estimate risk ratios for differences in bilateral salpingo-oophorectomy rates by disability status, adjusted for patient and clinical factors. Models were stratified by potentially avoidable or potentially appropriate bilateral salpingo-oophorectomy based on the presence of clinical indications for ovarian removal and by age group., Results: Bilateral salpingo-oophorectomy at the time of benign hysterectomy occurred in 26.0% of females without a disability, with rates clearly elevated in those with a physical (33.2%; adjusted risk ratio, 1.10; 95% confidence interval, 1.05-1.14) or intellectual or developmental (31.1%; adjusted risk ratio, 1.32; 95% confidence interval, 1.02-1.64) disability, possibly elevated in those with multiple disabilities (38.2%; adjusted risk ratio, 1.20; 95% confidence interval, 0.94-1.45), and similar in those with a sensory disability (31.2%; adjusted risk ratio, 0.98; 95% confidence interval, 0.83-1.13). The results were similar but with lower statistical precision for potentially avoidable and potentially appropriate bilateral salpingo-oophorectomy, which occurred in 9.1% and 17.0% of females without a disability, respectively. The largest differences in bilateral salpingo-oophorectomy rates among women with any disability were observed in the perimenopausal 45- to 49-year age group., Conclusion: Females with disabilities experienced elevated concomitant bilateral salpingo-oophorectomy rates at the time of benign hysterectomy, particularly those with an intellectual or developmental disability and those of perimenopausal age, although some estimates were imprecise. Equity-focused physician training in surgical counseling and research into the epidemiology and experiences of gynecologic conditions among females with a disability may be beneficial., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: To compare results for surgery time, perioperative pain, need for rescue analgesia, variables, serum C-reactive protein concentration, and postoperative complications for dogs with pyometra treated with laparoscopic-assisted ovariohysterectomy (LaOVH) versus open-surgery (OS) ovariohysterectomy., Animals: 12 client-owned dogs with pyometra between June 1, 2016, and December 31, 2019., Methods: Dogs enrolled in this prospective single-center randomized clinical trial had pyometra confirmed by history, physical examination, ultrasonography, and blood work and were randomly assigned to treatment group LaOVH or OS. Differences in results for variables of interest were compared between groups using the Mann-Whitney U test, except the number of dogs requiring rescue analgesia was analyzed using the Fisher exact test. Values of P ≤ .05 were considered significant., Results: 6 dogs were recruited in each group; results for 1 dog in the LaOVH group were excluded from further analysis due to free abdominal fluid detected during surgery. Median surgery time was significantly shorter and median total incision length was longer for the OS group (23 minutes; 106 mm), compared to the LaOVH group (37 minutes; 38 mm). No other results differed significantly between groups., Clinical Relevance: Although fewer patients in the LaOVH group required rescue analgesia, this was not statistically significant. Therefore, our results could not prove previously suggested advantages of LaOVH (eg, less perioperative pain or faster recovery) in dogs with pyometra. Additionally, for the LaOVH group, the median surgical time was approximately 50% longer, an assistant was needed, and specialized equipment was required.

Immune thrombocytopenic purpura (ITP) is a disorder caused by autoimmune antibodies which target glycoprotein IIb/IIIa complex or other platelet membrane antigens leading to platelet destruction. These platelets are then cleared by the spleen resulting in thrombocytopenia. Immune thrombocytopenic purpura affects about 1 to 6.4 cases in 100 000 children making it one of the most common causes of symptomatic thrombocytopenia in the pediatric population. It is rare that children or adolescents present with serious bleeding due to ITP. Common presentations include petechiae, bleeding gums, or bruising. Bleeding requiring hospitalization or transfusions is unusual and only occurs in approximately 5% of children. Even more uncommon is the presentation of severe bleeding complications requiring surgery for resolution. We present a case of a 17-year-old girl with acute ITP complicated by intraperitoneal hemorrhage and refractory thrombocytopenia due to ovarian cyst requiring oophorectomy., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ligation of the feline ovarian pedicle during ovariohysterectomy is achieved, principally, via one of the following methods: double ligation of the ovarian pedicle or autoligation of the ovarian pedicle, also known as the pedicle tie. The objective of this study was to assess and quantify two methods of teaching feline ovariohysterectomies, specifically ligation of the ovarian pedicle, at American Association of Veterinary Medical Colleges-accredited veterinary schools. Surveys were sent to 52 AAVMC member schools, with an overall response rate of 67.3%. Of the 35 schools that responded to the survey, 34 (97.1%) reported that they teach double ligation of the feline ovarian pedicle, whereas 17 (48.6%) of respondents reported teaching autoligation of the feline ovarian pedicle (2 respondents indicated that a single ligature is sufficient). Only 1 of the schools that reported teaching pedicle ties indicated that it did not teach double ligation of the ovarian pedicle; 16 of the 35 schools that responded to the survey (45.7%) reported teaching both techniques. The results indicate that significantly fewer institutions are currently teaching autoligation of the feline ovarian pedicle than those teaching double ligation of the feline ovarian pedicle.

Background: Liposomal local anaesthetic solutions may provide extended-duration analgesia postoperatively but have not been assessed following intra-peritoneal local infiltration in any species., Objectives: To evaluate two doses of 1.33% liposomal bupivacaine (LB) versus 0.75% bupivacaine HCL (BHCl) for analgesia following laparoscopic ovariectomy in mares., Study Design: Prospective cohort study., Methods: Fifteen healthy Quarter Horse mares (age 2-20 years) with normal bilateral ovarian palpation and appearance were enrolled. Horses were restrained in standing stocks and administered an α-2 agonist, butorphanol, and flunixin meglumine, followed by a variable rate infusion of sedation with α-2 agonists. Bilateral paralumbar fossa ovariectomies were performed. Treatment with either 30 ml 0.75% BHCl followed by 20 or 40 ml LB 13.3% (LB20 and LB40) volume expanded with saline to 80 ml total (n = 6/group) or 80 ml BHCl alone (n = 3, BCHL) was infused around incision sites and each mesovarium (LB or BHCl) prior to ovariectomy. Horses were monitored for 72 h by physical examination, algometry, and pain scoring (composite pain scale by Bussieres et al., Horse Grimace Scale). Abdominocentesis with peritoneal fluid analysis was performed at 72 h., Results: Analgesia achieved with all treatment protocols allowed completion of ovariectomy procedures. Pressure algometry scores were lower in BHCl-treated horses versus both LB groups overall. Pain scores were improved with LB-treated horses in a dose-dependent fashion (Horse Grimace Scale scores LB40 < LB20 < BHCL; composite pain scale scores LB40 < BHCL, LB20 < BHCL, BHCL, and LB20 did not differ). Peritoneal fluid total protein was lower in LB40 versus LB20 and BHCL horses. No complications from LB administration were appreciated., Main Limitations: Small patient sample size, lack of follow-up past 72 h or histopathology., Conclusions: Analgesia duration was extended and pain scores improved postoperatively with LB versus BHCl in a dose-dependent fashion. Further clinical evaluation of extended-duration local anaesthetics in horses for improved postoperative pain management is warranted., (© 2022 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.)

Study Objective: To demonstrate the laparoscopic excision of a retroperitoneal adnexal cyst and describe the advanced surgical techniques and anatomic considerations in a patient with previous abdominopelvic surgery., Design: Stepwise demonstration of advanced laparoscopic techniques with narrated video footage., Setting: Adnexal masses after hysterectomy are a common reason for repeat abdominal surgery. 1 Up to 9% of patients may require future adnexal surgery if ovarian preservation was chosen at the time of hysterectomy. 2 Indications for surgery can include persistent adnexal masses, masses with concern for malignancy, chronic pelvic pain, and risk-reducing surgery. 2 This patient is a 53-year-old postmenopausal female with a history of a total abdominal hysterectomy and left salpingectomy who underwent excision of an 8 cm retroperitoneal left adnexal cyst (Still 1)., Interventions: Excision of a retroperitoneal adnexal cyst can be performed through a laparoscopic approach with several key strategies: CONCLUSION: Knowledge of retroperitoneal anatomy is crucial in the surgical management of retroperitoneal adnexal masses because dissection can be technically challenging and anatomy may be distorted due to pelvic adhesive disease. Use of advanced laparoscopic techniques and understanding surgical planes are important for safe dissection. High and early ligation of the infundibulopelvic ligament at the pelvic brim and a complete ureterolysis with parametrial excision are often necessary to remove all ovarian tissue to prevent an ovarian remnant., (Copyright © 2023 AAGL. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the effect of risk-reducing salpingo-oophorectomy (RRSO) on change in bone mineral density (BMD) in women aged 34-50 years with pathogenic variants in BRCA1 or BRCA2 ( BRCA1 /2)., Methods: The PROSper (Prospective Research of Outcomes after Salpingo-oophorectomy) study is a prospective cohort of women aged 34-50 years with BRCA1 or two germline pathogenic variants that compares health outcomes after RRSO to a non-RRSO control group with ovarian conservation. Women aged 34-50 years, who were planning either RRSO or ovarian conservation, were enrolled for 3 years of follow-up. Spine and total hip BMD were measured by dual-energy X-ray absorptiometry (DXA) scans obtained at baseline before RRSO or at the time of enrollment for the non-RRSO group, and then at 1 and 3 years of study follow-up. Differences in BMD between the RRSO and non-RRSO groups, as well as the association between hormone use and BMD, were determined by using mixed effects multivariable linear regression models., Results: Of 100 PROSper participants, 91 obtained DXA scans (RRSO group: 40; non-RRSO group: 51). Overall, total spine, and hip BMD decreased significantly from baseline to 12 months after RRSO (estimated percent change -3.78%, 95% CI -6.13% to -1.43% for total spine; -2.96%, 95% CI -4.79% to -1.14% for total hip) and at 36 months (estimated percent change -5.71%, 95% CI -8.64% to -2.77% for total spine; -5.19%, 95% CI -7.50% to -2.87% for total hip. In contrast, total spine and hip BMD were not significantly different from baseline for the non-RRSO group. The differences in mean percent change in BMD from baseline between the RRSO and non-RRSO groups were statistically significant at both 12 and 36 months for spine BMD (12-month difference -4.49%, 95% CI -7.67% to -1.31%; 36-month difference -7.06%, 95% CI -11.01% to -3.11%) and at 36 months for total hip BMD (12-month difference -1.83%, 95% CI -4.23% to 0.56%; 36-month difference -5.14%, 95% CI -8.11% to -2.16%). Across the study periods, hormone use was associated with significantly less bone loss at both the spine and hip within the RRSO group compared with no hormone use ( P <.001 at both 12 months and 36 months) but did not completely prevent bone loss (estimated percent change from baseline at 36 months -2.79%, 95% CI -5.08% to -0.51% for total spine BMD; -3.93%, 95% CI -7.27% to -0.59% for total hip BMD)., Conclusion: Women with pathogenic variants in BRCA1 /2 who undergo RRSO before the age of 50 years have greater bone loss after surgery that is clinically significant when compared with those who retain their ovaries. Hormone use mitigates, but does not eliminate, bone loss after RRSO. These results suggest that women who undergo RRSO may benefit from routine screening for BMD changes to identify opportunities for prevention and treatment of bone loss., Clinical Trial Registration: ClinicalTrials.gov , NCT01948609., Competing Interests: Financial Disclosure Mindy Goldman reports receiving payment from Madorra (a medical device startup) and Symposia Medicus (speaker). She is a medical advisor for Gabbi (stock options, no compensation). She is on the survivorship panel for the NCCN and Chair of the Menopause and Sexual Functioning panels (unpaid volunteer position). Julie Mak reports receiving payment from the National Comprehensive Cancer Network (speaker honorarium) and Johns Hopkins University Press (manuscript reviewer honorarium). She is also on an NCCN panel (unpaid volunteer position) for Genetic/High-risk/Familial Breast/Ovary/Pancreatic cancer and received reimbursed travel and conference fees for speaking at the National Consortium of Breast Centers conference. Victoria Bae-Jump reports that money was paid to her institution from Merck, Chimerix, and Genentech. The other authors did not report any potential conflicts of interest., (Copyright © 2023 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

The relationship between hysterectomy and ovarian preservation and depression is controversial. This study aimed to determine the association of hysterectomy and ovarian preservation with depression using National Health and Nutrition Examination Survey. To assess the association between hysterectomy with or without ovariectomy and depression, we used 3 methods. Method 1: propensity score model (PSM) was established. Method 2 was logistics regression analysis of hysterectomy and depression before and after PSM. Method 3 was a logistics regression analysis of the relationship between hysterectomy and different depressive symptoms. At the same time, in order to evaluate the association between hysterectomy with or without oophorectomy and depression, we explored the effect of four different surgical procedures on depression using logistic regression equations. We enrolled 12,097 women, of whom 2763 underwent hysterectomy, 34.455% were positive for depression. After weighting, 33.825% of the total sample had a PHQ ≥ 5. Finally, a total of 2778 women were successfully matched by propensity score, and 35.537% of them were positive for depression. The OR for PHQ ≥ 5 was 1.236 after crude adjustment of covariates and 1.234 after exact adjustment. This suggests that Hysterectomy is strongly associated with positive depression. Positive depression (PHQ ≥ 5) was associated with little interest, feeling down and trouble concentrating. It was not associated with trouble sleeping, feeling tired, poor appetite, feeling bad, slow moving or speaking, and suicidal thoughts. Oophorectomy-alone is not associated with depression. Hysterectomy-alone is a risk factor for depression, but Hysterectomy combined with Oophorectomy has a stronger correlation with depression than Hysterectomy-alone. Women who have had a Hysterectomy are at higher risk of depression than women who have not had a Hysterectomy, and this risk may be exacerbated if the uterus and ovaries are removed. When clinically appropriate, surgeons should try to preserve the patient's ovaries., (© 2023. The Author(s).)

Background: Risk-reducing salpingectomy with delayed oophorectomy has gained interest for individuals at high risk for tubo-ovarian cancer as there is compelling evidence that especially high-grade serous carcinoma originates in the fallopian tubes. Two studies have demonstrated a positive effect of salpingectomy on menopause-related quality of life and sexual health compared with standard risk-reducing salpingo-oophorectomy., Primary Objective: To investigate whether salpingectomy with delayed oophorectomy is non-inferior to the current standard salpingo-oophorectomy for the prevention of tubo-ovarian cancer among individuals at high inherited risk., Study Hypothesis: We hypothesize that postponement of oophorectomy after salpingectomy, to the age of 40-45 ( BRCA1 ) or 45-50 ( BRCA2 ) years, compared with the current standard salpingo-oophorectomy at age 35-40 ( BRCA1 ) or 40-45 ( BRCA2 ) years, is non-inferior in regard to tubo-ovarian cancer risk., Trial Design: In this international prospective preference trial, participants will choose between the novel salpingectomy with delayed oophorectomy and the current standard salpingo-oophorectomy. Salpingectomy can be performed after the completion of childbearing and between the age of 25 and 40 ( BRCA1 ), 25 and 45 ( BRCA2 ), or 25 and 50 ( BRIP1, RAD51C, and RAD51D pathogenic variant carriers) years. Subsequent oophorectomy is recommended at a maximum delay of 5 years beyond the upper limit of the current guideline age for salpingo-oophorectomy. The current National Comprehensive Cancer Network (NCCN) guideline age, which is also the recommended age for salpingo-oophorectomy within the study, is 35-40 years for BRCA1 , 40-45 years for BRCA2, and 45-50 years for BRIP1 , RAD51C , and RAD51D pathogenic variant carriers., Major Inclusion/exclusion Criteria: Premenopausal individuals with a documented class IV or V germline pathogenic variant in the BRCA1, BRCA2, BRIP1, RAD51C, or RAD51D gene who have completed childbearing are eligible for participation. Participants may have a personal history of a non-ovarian malignancy., Primary Endpoint: The primary outcome is the cumulative tubo-ovarian cancer incidence at the target age: 46 years for BRCA1 and 51 years for BRCA2 pathogenic variant carriers., Sample Size: The sample size to ensure sufficient power to test non-inferiority of salpingectomy with delayed oophorectomy compared with salpingo-oophorectomy requires 1500 BRCA1 and 1500 BRCA2 pathogenic variant carriers., Estimated Dates for Completing Accrual and Presenting Results: Participant recruitment is expected to be completed at the end of 2026 (total recruitment period of 5 years). The primary outcome is expected to be available in 2036 (minimal follow-up period of 10 years)., Trial Registration Number: NCT04294927., Competing Interests: Competing interests: None declared., (© IGCS and ESGO 2023. Re-use permitted under CC BY. Published by BMJ.)

Objectives: Standard treatment for endometrial cancer is a hysterectomy, bilateral salpingo-oophorectomy, and lymph node assessment. In premenopausal women, removal of the ovaries may not be necessary and could increase the risk of all-cause mortality. We sought to estimate the outcomes, costs, and cost-effectiveness of oophorectomy versus ovarian preservation in premenopausal women with early-stage, low-grade endometrial cancer., Methods: A decision-analytic model was designed using TreeAge software comparing oophorectomy to ovarian preservation in premenopausal women with early-stage, low-grade endometrial cancer. We used a theoretical cohort of 10,600 women to represent our population of interest in the United States in 2021. Outcomes included cancer recurrences, ovarian cancer diagnoses, deaths, rates of vaginal atrophy, costs, and quality-adjusted life years (QALYs). The cost-effectiveness threshold was set at $100,000/QALY. Model inputs were derived from the literature. Sensitivity analyses were conducted to evaluate the robustness of the results., Results: Oophorectomy resulted in more deaths and higher rates of vaginal atrophy, while ovarian preservation resulted in 100 cases of ovarian cancer. Ovarian preservation resulted in lower costs and higher QALYs making it cost effective when compared to oophorectomy. Sensitivity analyses demonstrated the probability of cancer recurrence after ovarian preservation and probability of developing ovarian cancer were the most impactful variables in our model., Conclusion: Ovarian preservation is cost-effective in premenopausal women with early-stage, low-grade endometrial cancer when compared to oophorectomy. Ovarian preservation may prevent surgical menopause, which may improve quality of life and overall mortality without compromising oncologic outcomes, and should be strongly considered in premenopausal women with early stage disease., Competing Interests: Declaration of Competing Interest The authors report no conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: Increasing evidence suggests the fallopian tube as the site of origin of BRCA1/2-associated high-grade ovarian cancers. Several ongoing trials are evaluating salpingectomy with delayed oophorectomy (RRSDO) for ovarian cancer risk reduction and patients are beginning to ask their clinicians about this surgical option. This study sought to systematically review the available literature examining patient preferences regarding RRSDO and risk-reducing salpingo-oophorectomy (RRSO) to provide clinicians with an understanding of patient values, concerns, and priorities surrounding ovarian cancer risk-reducing surgery., Methods: We conducted a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO No.: CRD42023400690). We searched key electronic databases to identify studies evaluating acceptance and surgical decision-making regarding RRSO and RRSDO among patients with an increased risk of ovarian cancer., Results: The search yielded 239 results, among which six publications met the systematic review inclusion criteria. Acceptance of RRSDO was evaluated in all studies and ranged from 34% to 71%. Factors positively impacting patients' acceptance of RRSDO included: avoidance of surgical menopause, preservation of fertility, concerns about sexual dysfunction, family history of breast cancer, and avoidance of hormone replacement therapy. Factors limiting this acceptance reported by patients included concerns regarding oncologic safety, surgical timing, and surgical complications., Conclusion: To date, few studies have explored patient perspectives surrounding RRSDO. Collectively, the limited data available indicate a high level of acceptance among BRCA1/2 carriers, and provides insight regarding both facilitating and limiting factors associated with patient preferences to better equip clinicians in the counseling and support of their patients., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To examine the trends and characteristics of ovarian conservation at time of hysterectomy in cervical carcinoma in situ., Methods: This is a retrospective cohort study examining the Healthcare Cost and Utilization Project's National Inpatient Sample, January 2016 to December 2019. The study population included 6605 patients aged less than 65 years with cervical carcinoma in situ who underwent hysterectomy. Exposure allocation was the adnexal procedure status (ovarian conservation vs. oophorectomy). Main outcome measures were temporal trends of ovarian conservation over time and per patient age. A classification-tree was constructed to examine utilization patterns of ovarian conservation., Results: Ovarian conservation was performed in 57.2% of patients. Ovarian conservation rates were unchanged over time (P-trend = 0.219). Ovarian conservation rates remained stable until age 40 years, ranging from 88.0% to 78.6% (P-trend = 0.236), after which time the rate sharply decreased from 78.6% to 19.1% (P-trend <0.001). In a multivariable analysis, younger age, fewer comorbidities, higher household income, vaginal hysterectomy, and surgery at small bed capacity non-rural hospitals were associated with ovarian conservation (all, P < 0.05). There were 17 utilization patterns of ovarian conservation for which the rate ranged from 17.2% to 94.4% (absolute rate difference 77.2%, P < 0.001)., Conclusion: Decrease in the utilization of ovarian conservation at hysterectomy for cervical carcinoma in situ occurred at age 40 years, which is earlier than expected., (© 2022 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

Objective: This study aimed to determine BRCA -mutation carrier women's interest and acceptability of participating in a study examining prophylactic salpingectomy with delayed oophorectomy (PSDO) as an alternative to the current recommendation for bilateral salpingo-oophorectomy for risk reduction., Methods: This is a cross-sectional questionnaire-based study. All women visiting the high-risk clinics for hereditary breast and ovarian cancer in a single tertiary medical center were asked to complete a questionnaire concerning the two-stage approach from October 2018 to December 2019. Before completing the questionnaire, detailed explanation was given by a senior physician regarding the procedure, related background, possible risks, and benefits., Results: The study population included 293 women, of whom 183 (62.4%) were BRCA1 mutation carriers, 97 (33.1%) were BRCA2 mutation carriers, and 13 (4.4%) had unknown familial mutation. Risk-reducing surgery was completed in 160 (55.17%) of the women. First-degree and second-degree family history was reported in 166 (57.24%) and 52 (17.9%) of the women, respectively. Among women surveyed, more than half of the women (n = 66 [51%]) who had yet to undergo risk-reducing surgery reported interest in having PSDO. Similarly, among those who had already received prophylactic surgery, 64 (40%) also considered PSDO to be an acceptable alternative. Multivariate logistic regression analysis found family history of related malignancies to be the only independent factor associated with reduced interest in a study of PSDO (odds ratio, 0.15 [95% confidence interval, 0.29-0.77]; P = 0.02)., Conclusions: Overall, BRCA -mutation carrier women indicated interest in PSDO risk-reducing surgery, taking into consideration the potential additional risk. These findings suggest that a clinical study exploring the equivalence of PSDO as alternative treatment is feasible., Competing Interests: Financial disclosure/conflicts of interest: None reported., (Copyright © 2023 by The North American Menopause Society.)

Background: More evidence is needed to substantiate current recommendations about removing ovaries during hysterectomy for benign conditions., Objective: To compare long-term outcomes in women with and without bilateral salpingo-oophorectomy (BSO) during hysterectomy for benign conditions., Design: Emulated target trial using data from a population-based cohort., Setting: Women in Denmark aged 20 years or older during 1977 to 2017., Participants: 142 985 women with hysterectomy for a benign condition, 22 974 with BSO and 120 011 without., Intervention: Benign hysterectomy with or without BSO., Measurements: The primary outcomes were overall hospitalization for cardiovascular disease (CVD), overall cancer incidence, and all-cause mortality through December 2018., Results: Compared with women without BSO, women with BSO who were younger than 45 years at surgery had a higher 10-year cumulative risk for hospitalization for CVD (risk difference [RD], 1.19 percentage points [95% CI, 0.09 to 2.43 percentage points]). Women with BSO had a higher 10-year cumulative risk for cancer for ages 45 to 54 years (RD, 0.73 percentage point [CI, 0.05 to 1.38 percentage points]), 55 to 64 years (RD, 1.92 percentage points [CI, 0.69 to 3.25 percentage points]), and 65 years or older (RD, 2.54 percentage points [CI, 0.91 to 4.25 percentage points]). Women with BSO had higher 10-year mortality in all age groups, although the differences were statistically significant only for ages 45 to 54 years (RD, 0.79 percentage point [CI, 0.27 to 1.30 percentage points]). The mortality at 20 years was inconsistent with that at 10 years in women aged 65 years or older., Limitation: Age was a proxy for menopausal status., Conclusion: The authors find that these results support current recommendations for conserving ovaries in premenopausal women without a high risk for ovarian cancer and suggest a cautious approach in postmenopausal women., Primary Funding Source: The Danish Cancer Society's Scientific Committee and the Mermaid Project., Competing Interests: Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-1628.

Objective: To evaluate incidences of pyometra and orthopedic, behavioral, urinary/reproductive, neoplastic, or atopic disease processes as outcomes for dogs undergoing either a laparoscopic-assisted ovary-sparing spay/hysterectomy (LapOSS) or a laparoscopic ovariectomy (LapOVE)., Animals: 33 client-owned dogs., Procedures: Medical records of client-owned dogs presenting between August 2013 and May 2020 for elective LapOSS or LapOVE were reviewed. A multiple-choice client questionnaire was emailed to all clients whose dogs' complete medical records were available., Results: 17 of the 33 dogs were in the LapOSS group, and 16 of 33 dogs were in the LapOVE group. Of the 17 dogs undergoing LapOSS, 5 of 17 (29%) underwent an elective OVE at a later date. The mean follow-up time was 4.2 ± 1.8 years for the LapOSS group and 4.3 ± 2.0 years for the LapOVE group. No dogs developed stump pyometra. One LapOSS dog developed mammary tumor, and 2 others developed nonreproductive malignant neoplasia while 2 of the LapOVE dogs developed malignant neoplasia. One of the LapOSS dogs with malignant neoplasia had an ovariectomy prior to development of disease., Clinical Relevance: Laparoscopic-assisted ovary-sparing spay appears to provide a safe and reliable method of sterilization, with no observable increased risk of pyometra with hysterectomy. Owners must be counseled prior to surgery regarding the consequences of gonadal hormone retention and multiple heat cycles.

Background: As more transgender and gender-diverse patients undergo hysterectomy, gaps in knowledge remain about how testosterone dosing or other physiologic parameters change following surgery and how these are influenced by concomitant oophorectomy., Aim: The aims of this study were to determine the incidence of testosterone dosing change after gender-affirming hysterectomy and to compare this incidence between patients who underwent oophorectomy and ovarian preservation., Methods: This multicenter retrospective cohort study consisted of transmasculine patients who underwent hysterectomy for gender affirmation., Outcomes: Outcome measures included testosterone dosing changes at least 3 months following hysterectomy, as identified by clinical documentation, as well as clinical and laboratory parameters assessed for a change after hysterectomy: free and total testosterone, estradiol, hemoglobin, hematocrit, total cholesterol, weight, and blood pressure., Results: Of the 50 patients, 32 (64%) underwent bilateral oophorectomy, 10 (20%) unilateral oophorectomy, and 8 (16%) maintained both ovaries. Eight percent (n = 4) changed testosterone dosing following hysterectomy. Those who underwent bilateral oophorectomy were no more likely to change their testosterone dose than those who did not (P = .09). Those who also used menstrual suppression were 1.31 times more likely to change doses of testosterone after hysterectomy (95% CI, 1.09-1.82; P = .003). For those who had pre- and posthysterectomy laboratory and clinical values, the majority saw no clinically significant change. However, among patients who underwent bilateral oophorectomy, the calculated free testosterone increased by 90.1 ± 288.4 ng/dL (mean ± SD), and estradiol dropped by 20.2 ± 29.0 pg/mL., Clinical Implications: In a field where access to care can be a significant barrier, there is unlikely to be a need for routine reassessment of testosterone dose or laboratory parameters following hysterectomy, whether or not a bilateral oophorectomy occurs., Strengths and Limitations: Limitations of the study include its retrospective nature and the lack of consistent clinical laboratory testing, which resulted in limited data about any given hormonal change. The heterogeneity of our population limited the number of patients undergoing or not undergoing oophorectomy; however, it allowed our study to more truly reflect a clinical environment., Conclusion: In a multisite cohort of individuals who underwent hysterectomy for gender affirmation, few patients changed testosterone dosing after surgery. In addition, dosing change was not associated with the presence or absence of bilateral oophorectomy, and most measured laboratory values remained consistent following hysterectomy., (© The Author(s) 2023. Published by Oxford University Press on behalf of The International Society of Sexual Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Hysterectomy and bilateral oophorectomy are common major surgical procedures that have been associated with increased mortality risk. We aimed to assess the association of hysterectomy and/or bilateral oophorectomy with all-cause and cardiovascular mortality in a Norwegian population., Material and Methods: Cohort study with data from The Trøndelag Health Study (HUNT2) linked to the Norwegian Cause of Death Registry, with follow-up from 1996 until 2014 or death. The unexposed group (n = 18 673) included women with both their ovaries and uterus intact, while the two exposed groups included women with hysterectomy alone (n = 1199), or bilateral oophorectomy with or without hysterectomy (n = 907). We compared mortality in exposed vs unexposed groups and adjusted for relevant covariates by Cox regression. Further, we performed analyses stratified by age at surgery (≤39, 40-52, ≥53 years) and subgroup analyses among women ≤52 years of age at inclusion., Results: Among the 47 312 women in HUNT2 (1995-1997), 20 779 provided complete information regarding gynecological surgery and previous health. The hysterectomy group had increased all-cause mortality (hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.06-1.58) and cardiovascular mortality (HR 1.47, 95% CI 1.09-1.97). We found no significant association between bilateral oophorectomy and all-cause or cardiovascular mortality in the total population. However, among women ≤52 years at inclusion, cardiovascular mortality was increased in the hysterectomy group (HR 2.71, 95% CI 1.19-6.17) with a similar, but less precise estimate in the bilateral oophorectomy group (HR 2.42, 95% CI 0.84-6.93)., Conclusions: Hysterectomy was associated with increased all-cause and cardiovascular mortality, whereas bilateral salpingo-oophorectomy was not. Among women ≤52 years at inclusion, both hysterectomy and bilateral oophorectomy were associated with a twofold increased risk of cardiovascular mortality, but the results were imprecise. Women after hysterectomy and/or bilateral salpingo-oophorectomy constitute a group with increased cardiovascular mortality that may need closer attention to cardiovascular disease risk from the healthcare system to ensure timely and effective preventive interventions., (© 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Objective: The objective of this study was to determine the incidence of successful bilateral salpingo-oophorectomy at the time of vaginal hysterectomy for pelvic organ prolapse and to evaluate associated factors and success rate over time., Study Design: This was a retrospective chart review of all women who underwent vaginal hysterectomy for pelvic organ prolapse who were consented for bilateral salpingo-oophorectomy "if possible" and "including extraordinary measures" between 2014 and 2019 at a tertiary medical center. Baseline demographic data along with prolapse stage, operative findings, operative time, and complications were recorded. Univariate analysis using the Pearson's chi-square test, the student's t-test or Mann Whitney U test when appropriate and multivariable logistic regression was performed to determine predictors of successful vaginal bilateral salpingo-oophorectomy., Results: A total of 453 eligible patients were included. 420 patients (92.7 %) were consented for bilateral salpingo-oophorectomy "if possible" and 33 patients (7.3 %) were consented for "including extraordinary measures". The success rate of vaginal bilateral salpingo-oophorectomy in all patients was 57.9 % (n = 262). Of the patients consented for extraordinary measures, the success rate was 93.9 % (n = 31), compared to a success rate of 55 % (n = 231) in the "if possible" group. A concurrent posterior repair was found to have higher odds of successful bilateral salpingo-oophorectomy (adjOR 1.75 [95 % CI = 1.17-2.61]). Successful bilateral salpingo-oophorectomy extended operative time by 14 min (154 min vs 140 min, p < 0.001). Compared to patients in the unsuccessful group, the successful group had a higher proportion of the following indications: a family history of ovarian cancer, personal breast cancer history or patient request for definitive removal., Conclusion: When the pre-operative intention to perform bilateral salpingo-oophorectomy at the time of vaginal hysterectomy for pelvic organ prolapse is high, the success rate is nearly 40% higher when compared to an opportunistic procedure. This suggests that success is closely linked to the surgeon's determination to complete this procedure vaginally., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Postmenopausal women have a higher susceptibility to obesity and chronic disease. Piceatannol (PIC), a natural analog of resveratrol, was reported to inhibit adipogenesis and to have an antiobesity effect. In this study, PIC's effect on postmenopausal obesity and the mechanism of its action were investigated. C57BL/6J female mice were divided into four groups and half of them were ovariectomized (OVX). Both OVX and sham-operated mice were fed a high-fat diet (HFD) with and without the addition of 0.25% of PIC for 12 weeks. The abdominal visceral fat volume was higher in the OVX mice than the sham-operated mice, and PIC significantly decreased the fat volume only in the OVX mice. Unexpectedly, expression levels of adipogenesis-related proteins in white adipose tissue (WAT) were suppressed in the OVX mice, and PIC did not affect lipogenesis in either the OVX or sham-operated mice. Regarding the expression of proteins associated with lipolysis, PIC activated the phosphorylation of hormone-sensitive lipase much more in the OVX mice, but it did not affect the expression of adipose triglyceride lipase. PIC also tended to induce the expression of uncoupled protein 1 in brown adipose tissue (BAT). These results suggest that by promoting lipolysis in WAT and deconjugation in BAT, PIC is a potential agent to inhibit fat accumulation caused by menopause.

Many transgender and gender diverse adolescents and young adults will pursue hysterectomy for the purpose of gender affirmation. This procedure often includes bilateral salpingo-oophorectomy (BSO), which has potential implications for long-term health should individuals choose to stop, or lose access to, exogenous testosterone. Although most of these individuals intend to remain on testosterone indefinitely, not all do, and little information exists on such cases following bilateral oophorectomy to guide counseling and practice. This case series documents 3 individuals who had interruptions in their testosterone use after hysterectomy with BSO for reasons including external barriers, internal barriers, and concerns about side effects. Patients should be appropriately counseled on hysterectomy options as bilateral oophorectomy is not required in the absence of specific indications., (Copyright © 2022. Published by Elsevier Inc.)

Purpose: To evaluate whether previous ovarian removal concomitant with benign hysterectomy improves prognosis in a cohort of women with breast cancer., Methods: In this nationwide register-based cohort study, risk of recurrence and mortality were examined in 4563 women with invasive breast cancer and previous bilateral salpingo-oophorectomy (BSO) concomitant with benign hysterectomy, during 1977-2018. Comparing with benign hysterectomy alone, hazard ratios (HRs) and 95% confidence intervals (CIs) were evaluated by Cox-proportional hazards regression models. Analyses were stratified on age at hysterectomy as a proxy for menopausal status (< 45, 45-54 and ≥ 55 years); tumor characteristics, estrogen receptor (ER)-status, and use of hormone therapy (HT) were included in multivariable models., Results: Compared with hysterectomy alone, premenopausal (< 45 years) BSO at benign hysterectomy was associated with an age and calendar period adjusted HR of 1.48 (95% CI 0.83-2.65) for breast cancer recurrence within 10 years of follow-up, a HR of 1.07 (95% CI 0.66-1.72) for overall mortality after breast cancer, and a HR of 0.59 (95% CI 0.26-1.32) for breast cancer-specific mortality. The corresponding HRs for postmenopausal (≥ 55 years) BSO at benign hysterectomy were 1.51 (95% CI 0.73-3.12) for recurrences, 1.34 (95% CI 0.74-2.44) for overall mortality, and 1.78 (95% CI 0.74-4.30) for breast cancer mortality. Adjusting for tumor characteristics, ER-status and HT did not alter the results., Conclusion: Results from this cohort study did not indicate an improvement in breast cancer prognosis when removing the ovaries at benign hysterectomy prior to the cancer diagnosis., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: The management of pediatric ovarian neoplasms (ON) is based on finding a balance between adequate surgical treatment and future reproductive capacity. We aimed to evaluate long-term results of patients who underwent surgery for ON., Methods: A retrospective cohort study design was used. Medical records of patients with ON were reviewed. They were invited to participate in a telephone-based survey assessing complaints, menstrual status, and post-surgical recurrence., Results: Eighty-five patients were operated for ON between 1995 and 2015. Median age at surgery was 14.7 years. 62.4% of patients had ovary-sparing surgery (OSS). Median tumor size in oophorectomy group was significantly larger than OSS group (p = 0.029). Median length of follow-up was 5.1 years. Recurrent/metachronous disease was not significantly different between OSS and oophorectomy groups (p = 1.000). In OSS group, irregular menses (p = 0.004) and painful menses (p = 0.002) were significantly higher than oophorectomy group., Conclusion: The main goal of treatment in pediatric ON is to find the right balance between adequate and appropriate tumor resection and maximal effort for fertility preservation. Our results showed no difference between oophorectomy and OSS in the terms of recurrence. Although irregular and painful menses were found to be significantly higher in the OSS group, longer follow-up and prospective studies are needed to clarify this issue., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: The aim of this study was to compare the analgesic efficacy of topical irrigation versus injection of lidocaine on the ovarian pedicle to provide analgesia in bitches ovariectomy. In the current study were monitored: increased blood pressure, heart rate and respiratory rate to identify an acute intraoperative nociceptive response. These parameters were registered at six times during the surgical procedure: grasping of the ovary (time 1), dissection of the mesosalpinx (time 2), tightening of the first loop ligature (time 3), tightening of the second loop ligature (time 4), transection of the ovarian pedicle (time 5) and release of the ovary (time 6)., Material and Methods: Forty healthy bitches were randomly assigned in two groups (n = 20) to receive topical irrigation (splash block) of 2% lidocaine (C group) on both ovarian pedicle (2 mg/kg each), or an equal volume of lidocaine was injected at the same sites (R group)., Results: The results of the present study suggest that splash block may provide intraoperative analgesic effects equivalent to injection in the ovarian pedicle in dogs that have undergone ovariectomy. The lidocaine improved surgical analgesia during canine ovariectomy in both groups, and this action is not affected by the inoculation technique., Clinical Significance: Pain management in veterinary patients is a crucial component of appropriate patient care. Therefore, the need for achieving safer anaesthesia for surgical intervention is gaining much attention. Ovariectomy is a common surgical procedure in bitches with medium level of pain. This study concluded that considering its relative simplicity, low cost, and safety, both techniques could be used in daily clinical practice., (© 2022 The Authors. Veterinary Medicine and Science published by John Wiley & Sons Ltd.)

Background: Pharmacopuncture is an acupuncture-related technique that has been used to amplify the therapeutic effects of different medications., Objectives: To investigate the analgesic efficacy of a lidocaine injection at acupoints in cats undergoing ovariohysterectomy., Methods: Thirty cats were randomly distributed into two groups ( n = 15, per group). The experimental group received a bilateral administration of lidocaine at the following acupoints: Stomach 36 (ST-36) and Spleen 6 (SP-6) (Lido group). The control group did not receive lidocaine (Control group). All cats were sedated with dexmedetomidine and anesthesia was induced with propofol and maintained with isoflurane. Intraoperatively, fentanyl was given to control cardiovascular responses to surgical stimulation. Postoperative pain was assessed at various time points, up to 24 hours after extubation, using the UNESP-Botucatu multidimensional composite pain scale (MCPS) and Glasgow feline composite measure pain scale (CMPS-Feline). Sedation scores were measured at the same time points. Morphine/meloxicam was administered as rescue analgesia. Data were analyzed using t-tests, Fisher´s exact test, the Mann-Whitney test, and the Friedman test ( p < 0.05)., Results: Intraoperatively, more cats in the Control group required analgesic supplementation than those in the Lido group, but the difference was not significant ( p = 0.65). Postoperative pain, sedation scores, and analgesic requirements did not differ between groups. Rescue analgesia was given to 67% (10/15) of the cats in each group., Conclusion: The administration of lidocaine at ST-36 and SP-6 acupuncture points did not provide significant perioperative analgesic benefits in healthy cats undergoing ovariohysterectomy.

Objectives: The aim of this study was to evaluate the analgesic efficacy of oral tramadol in cats undergoing ovariohysterectomy., Methods: Twenty-four female domestic cats, American Society of Anesthesiologists class I, aged 4-24 months, were included in this positive controlled, randomised, blinded clinical trial. Cats admitted for ovariohysterectomy were allocated to group oral tramadol (GOT, n = 12) or group intramuscular tramadol (GIMT, n = 12). In GOT, tramadol (6 mg/kg) was given orally 60 mins, and saline was given intramuscularly 30 mins, before induction of anaesthesia. In GIMT, granulated sugar in capsules was given orally 60 mins and tramadol (4 mg/kg) intramuscularly 30 mins before induction of anaesthesia. In both groups, dexmedetomidine (0.007 mg/kg) was given intramuscularly 30 mins before induction of anaesthesia with intravenous propofol. Anaesthesia was maintained with isoflurane in oxygen, and atipamezole (0.037 mg/kg) was given intramuscularly 10 mins after extubation. The UNESP-Botucatu multidimensional composite scale was used to conduct pain assessments before premedication and at 20, 60, 120, 240 and 360 mins post-extubation or until rescue analgesia was given. To compare groups, the 60 min postoperative pain scores and the highest postoperative pain scores were analysed via a two-tailed Mann-Whitney test, and the incidences of rescue analgesia were analysed via a Fisher's exact test; P <0.05., Results: There was no significant difference between groups for the 60 min ( P  = 0.68) pain scores. The highest postoperative pain score was higher for GIMT compared with GOT ( P  = 0.04). Only two cats required rescue analgesia, both from GIMT. The incidence of rescue analgesia was not significantly different between groups ( P  = 0.46)., Conclusions and Relevance: In the present study, preoperative administration of oral tramadol at 6 mg/kg to cats provided adequate analgesia for 6 h following ovariohysterectomy surgery.

Objectives: This study aimed to compare the analgesic effect between carprofen and grapiprant every 12 or 24 h on postoperative pain in cats undergoing ovariohysterectomy, in addition to the effects on the hematological, biochemical and urinalysis variables., Methods: A total of 32 female cats were randomly divided into three groups, according to the treatment administered with the first dose given orally 90 mins before surgery, as follows: CAR (cats received 4 mg/kg carprofen, n = 11); GRA1 (cats received 2 mg/kg grapiprant, n = 10); and GRA2 (cats received 2 mg/kg grapiprant q12h, n = 11). Pain was assessed by UNESP-Botucatu Multidimensional Composite Pain Scale (UNESP) and Glasgow Feline Composite Measure Pain Scale (GLASGOW) for cats preoperatively (baseline) and at 1, 3, 6, 8, 12 and 24 h after extubation. Venous blood was collected at baseline, and 12 and 24 h after the administration of carprofen or grapiprant to perform a complete blood count (CBC), the percentage of Heinz bodies and serum biochemistry (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyltransferase, creatinine and urea). Urinalysis was performed at baseline and 24 h after extubation. Glucose levels were evaluated at baseline and 1 h postoperatively., Results: Pain scores were not significantly different among groups in both scales, although pain was higher at 3 h in comparison with 24 h in all groups. In the GRA1 and GRA2 groups, 67% (14/21) of cats needed rescue analgesia compared with 18% (2/11) in the CAR group. Glucose increased from baseline to 1 h in the GRA1 and GRA2 groups. None of the CBC, serum biochemistry and urinalysis variables differed among groups., Conclusions and Relevance: Grapiprant did not promote adequate analgesia during the first 3 h postoperatively in cats undergoing ovariohysterectomy compared with carprofen, and no benefits were observed by administering grapiprant every 12 h.

Background and Objectives : BRCA 1 and 2 mutations have a cumulative risk of developing ovarian cancer at 70 years of 41% and 15%, respectively, while a cumulative risk of breast cancer by 80 years of age was 72% for BRCA1 mutation carriers and 69% for BRCA2 mutation carriers. The NCCN recommends risk-reducing salpingo-oophorectomy (RRSO), typically between 35 and 40 years, and upon completion of childbearing in BRCA1 mutation, while it is reasonable to delay RRSO for management of ovarian cancer risk until age 40-45 years in patients with BRCA2. In recent years there have been two main lines of evolution in laparoscopy. The former concerning the development of a single-site laparoscopic and the latter concerning the miniaturisation of laparoscopic instruments (mini/micro-laparoscopy). Materials and Methods : In this case report, we show our experience in prophylactic adnexectomy, on a mutated-BRCA patient, using the MiniLap ® percutaneous surgical system. Results : This type of technique is safe and effective and does not require a particular learning curve compared to single-port laparoscopy. Conclusions : The considerable aesthetic advantage of the scars, we believe, albeit to a lesser extent, is useful to find in these patients burdened by an important stress load.

Objectives: To combine laparoscopic techniques with natural orifice transluminal endoscopic surgery (hybrid NOTES) to minimize number and enlargement of paralumbar laparoscopic portals for bilateral ovariectomy in standing, sedated mares., Study Design: Case series., Animals: Six horses., Materials and Methods: Six mares with palpably normal ovaries were restrained in stocks, sedated, and had caudal epidural anesthesia performed. A 7.5 MHz ultrasound probe was used transvaginally to select placement of vaginotomy. An attempt was made to remove both ovaries with 70 cm esophageal forceps through the vaginotomy, while visualized and transected via ipsilateral paralumbar fossa laparoscopic portals. Surgical time, intraoperative, and postoperative complications were recorded. Vaginoscopy was performed at days 0, 3, 7, and 14 postoperatively. After 14 days, mares were euthanized and necropsied., Results: Hybrid NOTES allowed successful bilateral ovariectomy in all six mares, with a mean surgical time of 70 ± 25 min. In two mares, one ovary was dislodged from the forceps during vaginotomy extraction. Abdominal retrieval of the ovary was successful with reapplication of forceps or a surgeon's hand via vaginotomy. At necropsy, five mares had no adhesions within the abdominal cavity or at the vaginotomy site. One mare in which hand retrieval of the ovary was necessary, developed an adhesion between the bladder and the vaginotomy., Conclusions: This technique appears to offer a safe alternative for bilateral ovariectomy with minimal postoperative complications., Clinical Significance: Decreased number and size of paralumbar laparoscopic incisions could decrease complications associated with exteriorization of ovaries through the flank., (© 2021 American College of Veterinary Surgeons.)

Objective: To determine the rate of complications associated with the ovarian pedicle tie procedure in cats undergoing ovariohysterectomy and examine whether cat characteristics or surgeon experience level were associated with complications., Animals: 15,927 cats that underwent ovariohysterectomy with the ovarian pedicle tie procedure between January 1, 2017, and December 31, 2018., Procedures: Data were extracted from electronic and paper medical records. Complications were coded by a veterinarian blinded to surgeon experience level. Complications (pedicle drop or tear, pedicle hemorrhage, and pedicle-related death) were summarized as counts and percentages. Univariate associations between cat characteristics (eg, age, weight, reproductive status, and ownership) and surgeon experience level (clinic veterinarian vs training veterinarian or veterinary student) and each outcome were estimated separately for veterinarian and student training clinics., Results: A pedicle drop or tear occurred in 0.3% (n = 49) of cats and was significantly more likely among veterinary students. Most (41/49 [84%]) pedicle drops and tears did not result in hemorrhage. Only 19 of 15,927 (0.12%) cats had pedicle-related hemorrhage, and in all instances, hemorrhage was corrected intraoperatively without serious complication or death. Cat characteristics and surgeon experience level were not related to pedicle hemorrhage., Clinical Relevance: Results support previous evidence that the ovarian pedicle tie procedure is safe in cats undergoing ovariohysterectomy when performed by experienced surgeons or novice surgeons under supervision. Given the reduced anesthetic time associated with the procedure, the ovarian pedicle tie should be considered an acceptable standard practice in all practice settings.

Objective: To compare the outcome of canine pyometra surgeries performed at referral hospitals with those performed at community clinics (outpatient settings), and to evaluate factors that impact outcome., Animals: 133 client-owned dogs with pyometra treated with ovariohysterectomy (OHE) at 2 community clinics or 2 referral hospitals between July 1, 2017, and June 30, 2019., Procedures: A retrospective electronic medical record search was used to identify eligible cases. Data about patient demographics and clinical characteristics were collected and analyzed for factors that could have impacted outcome., Results: Eighty-three dogs were treated at referral hospitals; 50 dogs were treated at community clinics. Survival to hospital discharge for all dogs was 97% (129/133) and did not differ between treatment facility type. Dogs treated at both types of facilities were similar in age, body weight, and clinical signs. Median duration between diagnosis and OHE was significantly shorter for dogs treated at referral hospitals (0 day; range, 0 to 0.7 days) versus community clinics (1.0 day; range, 0 to 14.0 days); however, delay was not related to survival to hospital discharge. Duration of hospitalization did not impact survival to hospital discharge nor survival for at least 1 week after surgery., Clinical Relevance: Results indicated that OHE for pyometra in dogs has a good outcome and that, although prompt surgical treatment remains a goal, in cases where limitations to performing surgery exist, a delay until surgery or discharging patients the same day is still associated with a high degree of success.

Objective: To investigate the impact of cystectomy for borderline ovarian tumor (BOT) on tumor recurrence compared with salpingo-oophorectomy using inverse probability of treatment weighting (IPTW)., Methods: A central pathologic review and a search of the medical records from 14 collaborating institutions from 1986 to 2017 identified 4708 women with a malignant ovarian neoplasm. Data for young women with Stage I BOT were extracted. To compare recurrence-free survival between the surgery groups, Cox regression analyses and the IPTW-adjusted Kaplan-Meier method were employed., Results: During a median follow-up of 62.0 (1.2-270.4) months, 10 of the 285 patients identified (3.5%) developed recurrence. In multivariate analysis, the practice of cystectomy was not a significant prognostic indicator of recurrence-free survival (hazard ratio [95% confidence interval] 1.276 [0.150-10.864]; P = 0.823). In the IPTW-adjusted cohort, the 5-year recurrence-free survival rates were 95.8% and 96.0% in patients receiving cystectomy and salpingo-oophorectomy, respectively (P = 0.378)., Conclusion: If patients are selected appropriately, cystectomy in itself may not increase tumor recurrence in young women with early-stage BOT. A large-scale prospective clinical study is necessary to validate this finding., (© 2021 International Federation of Gynecology and Obstetrics.)