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Moments in Surgical History |

Needle Aspiration and Ovarian Cyst

Ira M. Rutkow, MD, MPH, DrPH
Arch Surg. 1998;133(1):107. doi:10-1001/pubs.Arch Surg.-ISSN-0004-0010-133-1-ssh7007.
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OF THE MANY American surgical tours de force that occurred during the early to mid-19th century, the attempted performance of ovariotomy was among the most notable. However, because these early oophorectomies for massive enlargement of the ovaries found little favor secondary to their generally poor results, the only other reasonable treatment that could be offered the hapless sufferer was palliation by "tapping" (ie, to repeatedly withdraw the ever-reaccumulating fluid). Not surprisingly, the clinical stories of constantly removing increasing amounts of "cyst material" are staggering. As reported in Paul Eve's (1806-1877) A Collection of Remarkable Cases in Surgery (1857), one physician told of a case in which paracentesis was completed 80 times on the same patient during a 25-year span with an accumulated removal of 3136 L of fluid. Another surgeon described an ovarian cyst from which 193 kg of fluid was withdrawn in 10 months. Although official medical records were not kept, the most amazing anecdote was reported in 1825, when an ovarian cyst, or more likely the peritoneal cavity for recurring ascites, was supposedly tapped 299 times (during the course of several years) to remove the almost unbelievable total of 4460 kg of fluid. In view of these frightening numbers and the uniformly poor operative results, it is easy to understand why surgeons were fearful of attempts at needle aspiration and surgical extirpation. Charles Meigs (1792-1869), a respected Philadelphia, Pa, clinician, even went so far as to legislatively attempt to have ovariotomy prohibited, insisting that it was immoral and not justified by any number of surgical successes.

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This crude engraving from Edmund Peaslee's (1814-1878) Ovarian Tumors: Their Pathology, Diagnosis, and Treatment, Especially by Ovariotomy (1872) demonstrates what he termed the "fourth stage" of an ovarian cyst, including enlarged veins on the abdomen.

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