If you tried to do a biopsy of it, you really would not be left with very much tissue and you would then damage by default coming across the ovarian cortical surface, some of the follicles that are there.
The fimbria are very fragile and you can get some scarring and you'll find a hydrosalpinx later. So yes, protecting the fallopian tube is extremely important.
epidemiologicalAround 20 to 30% of families will intervene and ask to do something to preserve fertility.↗
▶Ep 454 · 1:54
guidelineAll patients and families should receive fertility counseling, as this is a standard recommended by major societies including ASCO, AAP, and ASRM.↗
▶Ep 454 · 1:54
quoteI think one of the sort of standards now is that all patients and families should be receiving counseling. Families have definitely shown us is extremely important to them.↗
▶Ep 454 · 1:54
guidelineCounseling should occur and be documented prior to the start of high-risk chemotherapy, even if families don't proceed with any surgery.↗
▶Ep 454 · 3:15
clinicalFor a pre-pubertal girl, a CED (cyclophosphamide equivalent dose) of 8 to 12 grams or more places them at high level of risk for premature ovarian insufficiency, making them a candidate for oophorectomy.↗
▶Ep 454 · 3:15
clinicalFor a post-pubertal patient, a CED of 4 grams per meter squared or more indicates high risk for premature ovarian insufficiency.↗
▶Ep 454 · 4:36
quoteIf you tried to do a biopsy of it, you really would not be left with very much tissue and you would then damage by default coming across the ovarian cortical surface, some of the follicles that are there.↗
▶Ep 454 · 4:36
quoteThe size of this child's ovary is about 2 centimeters. It's about the size of a grape and that really what you ought to do is a laparoscopic oophorectomy.↗
▶Ep 454 · 4:36
clinicalA pre-pubertal child's ovary is about 2 centimeters in size, approximately the size of a grape.↗
▶Ep 454 · 4:36
clinicalLaparoscopic oophorectomy rather than biopsy is the best recommendation for pre-pubertal patients because a biopsy can damage the ovary and put the child at high risk for hemorrhage, which would impact the child's ability to start stem cell transplant or chemotherapy.↗
▶Ep 454 · 4:36
clinicalRe-implanted ovarian strips can restore ovarian function for about two to five years and can result in live birth.↗
▶Ep 454 · 4:36
epidemiologicalLive birth from re-implanted ovarian tissue has occurred in two children who were nine years old, but has not yet happened in anyone younger in the United States.↗
▶Ep 454 · 4:36
clinicalA small biopsy of one ovary would not give enough tissue to sustain a child's entire reproductive future.↗
▶Ep 454 · 6:51
clinicalSurgeons should stay at least a centimeter away from the ovarian capsule because that's where all the follicle pool is located.↗
▶Ep 454 · 6:51
clinicalIn a piglet model that mimics a pre-pubertal child, if surgeons stay at least a centimeter away from the ovarian capsule, there were healthier tissue parameters including production of glucose, decreased lactose, and increased estradiol from ovarian follicles in culture.↗
▶Ep 454 · 6:51
clinicalThe Cool Seal device has a 3 mm option suitable for really small children and can help maintain distance from the ovarian capsule.↗
▶Ep 454 · 6:51
quoteThe fimbria are very fragile and you can get some scarring and you'll find a hydrosalpinx later. So yes, protecting the fallopian tube is extremely important.↗
▶Ep 454 · 6:51
clinicalThe fimbria are very fragile and can develop scarring leading to hydrosalpinx later if not protected during surgery.↗
▶Ep 454 · 6:51
quoteIn general, you want to stay away from the ovarian capsule because that's where all the follicle pool is and we do have an animal model. It's the best we have at this point. A piglet model that mimics a pre-pubertal child.↗
▶Ep 454 · 9:26
epidemiologicalIn Dr. Rowell's experience with about 140 patients, 17 had abdominal pelvic tumor surgery within a month of their laparoscopic oophorectomy, at a median of 29 days after open surgery.↗
▶Ep 454 · 9:26
epidemiologicalOf 17 patients who had recent abdominal pelvic tumor surgery, 16 underwent laparoscopic oophorectomy with no trouble, and one was done open by choice because they needed another tumor biopsy.↗
