Resection of a 303.2-pound ovarian tumor

A woman with a 303.2-pound ovarian mass is presented. She had been bedridden for the previous 2 years and housebound for 6 years due to the enlarging mass. Psychological factors enabling this patient to remain home and sabotage attempts of her family to obtain help must be considered and dealt with while obtaining preoperative consultation with each of the services ultimately to be involved in the patient's care. Psychiatric, pulmonary, nutritional, cardiac, endocrinologic, reconstructive surgery, anesthesia, and operating room nursing assessment and advice should be sought. Despite the large size, there is a one-third chance of finding a malignancy, suggesting that all of these large masses should be removed intact whenever possible. An elliptical transverse incision from iliac crest to iliac crest offers the best preservation of abdominal wall anatomy and function. Invasive cardiac and pulmonary monitoring should continue through the operation and afterward, as severe cardiopulmonary/hemodynamic compromise is possible. Long-term psychiatric follow-up is needed as the dramatic anatomic restoration is not always accompanied by a similar psychologic restoration.