LSH: LSH or TAH... my 2 options

Hi all. First of all, LOVE this site. I have surgery scheduled for May 17, 2010 (right around the corner!) and just decided to start reading about things. I'm actually not scared or nervous, I'm actually looking forward to no more excruciating fibroid pain and excessive bleeding.

I did have myomectomy performed in January to try to remove the fibroid, but it's embedded too far into my uterine wall and they couldnt get it. Ablation is not an option because it still would not get the fibroid, so after a few months of monitoring the situation, my doc and I decided on a hysterectomy. I am 39, I have no children, but I made the choice not to have any, so I'm completely fine with the finality of this procedure. (I rescue dogs, and I figure if I ever change my mind about children, I'll rescue one of those too)

MY QUESTION/DILEMMA. I have LSH scheduled, but am considering TAH. (I am not a good candidate for lap total vaginal assist because I have not had children, so for my doc to remove the cervix also, it will have to be abdominal.) After reading about different types of hyst and complications and recovery, I'm second guessing KEEPING my cervix. It's been 10 yrs, but I did have cryosurgery for pre-cancer cells (caught just in time). I've read that keeping the cervix you could still have mini periods, may need cauterization, may need the cerv removed later. My thinking, why not just do it all now and be DONE with my pain and problems. I know the recovery for TAH vs. LSH is significant, but a couple/few more weeks NOW versus a plethora of possible future problems with the cervix...it feels like a no brainer. I dont care about paps, I dont care about a scar (have a small one on my face for petes sake), prolapse is a risk with any hyst, and I have an abundance of care and support from my fella and family, AND the best thing of all, I can work from home for a few weeks and have an awesome job (been there 19 yrs) so not worried about work, AND last but not least, my ins. deductible is already met from my first surgery.

My sister had a total hyst in January, kept ovaries same as I will be. She did have vag assist, but the uterus and cervix are both gone and she's doing great.

Am I crazy for thinking of changing it from LSH to TAH ??? I just do NOT want any future problems, and have a very high pain tolerance and am very *tough* (haha) so not too worried about the extra recovery. My doc said he's totally on board and completely understands where I'm coming from given my history.

Thoughts please. And thanks for reading such a long post!!

Hugs and thoughts go out to all. Even though I'm not too scared or worried, I have nothing but compassion for those who are. Best wishes! Jill

Hi Jill! We are in a similar circumstance - I just turned 40, no kids, and have two SPCA rescue dogs (incl 1 senior who was just diagnosed with prostate cancer...boohoo). I am scheduled for a LSH procedure on May 11th (WOOHOO). Regarding my cervix, I have opted to keep every healthy part and there was no medical reason to remove my cervix. I have weighed everything out, as it sounds like you have, and for me it really did come down to keeping as many parts as I can. I am not concerned about paps, or possibly even a mini period. I want to reclaim my life and having a mini period would be nothing compared to major blood loss and anaemia! However, my understanding is that they can remove your cervix with the lap procedure as well...which would possibly address your concerns about your cervix but also provide you a less invasive procedure. I have heard from some sources that they have a much better "view" with an abdominal but the surgeon who will be doing my LSH said he doesn't agree...that he has a perfect view via Lap because everything is expanded from the gas, and there is no blood to speak of. He is very experienced though (nearly 1000 times he has performed the LSH procedure) so I'm sure that makes a difference.

Wishing you the very, very best in your final decision and your procedure! Please keep us posted!

And yes, this site rocks!!!

Wow, yours is right around the corner! Lots of luck for a flawless surgery and speedy recovery. Thank you for your response. I'm guessing my doc isn't as experienced as yours is with a full lap. And my insurance deductible resets May 31, so I don't really want to look around. I really like my doc, so I'm okay with it. I'm supposed to call him early next week with my decision. I've had cervical probs in the past, but am okay now. I guess my mind is thinking just get it all done now and be done. With my luck and my problems, I WOULD be someone that still had pain and bleeding with my cervix. But my brain is going crazy thinking. I TOTALLY get where you're coming from, keep as much as possible, and that's what my doc wants to do too. I've just had such a bad year, I dont want any future issues. Ugh... Best of luck to you next week !

Thank you for your good wishes! Can I ever relate about overactive brain activity....but really it's all a good thing. This is a MAJOR event in our lives and I think it's important that we allow ourselves to think it through completely so we feel great/no regrets on the other side. I totally understand what you mean about wanting this done and over with and hopefully no repeats in the future.

It's great you have confidance in your doctor, I think that is so important.....I had to search for the one I have now, had a very bad experience with the first guy. So I think it is also way better to have a successful TAH than a less successful lap procedure, if you decide to take the full uterus/cervix. Although the recovery time is longer, it sounds like you have that covered already in terms of working at home. And just think....one day we will look back on this and hardly even remember the details that consume us right now!! Won't that be great!? There was a thread on here about how powerful it is to be 40ish and reclaiming our lives....I still can't imagine life without pain, missing work, and generally not being my energetic sparkly person....I want that back!!!

I admire what you do for a living....you go girl! And hang in there....it sounds like you are 95% of the way to making your decision...or maybe in truth you have already made it?

jillr331 -

I am glad that you found this site.

I wanted to address your one comment about not being a candidate for a vaginal total hysterectomy because you never had children. There are many members here including myself that have had vaginal hysterectomies, not having children does not preclude you from this type of surgery.

You may also want to discuss the possibility of a daVinci laproscopic procedure. The robotic system allows better visualization of the area and if you have an experience surgeon it is no longer than a regular laproscopic procedure.

Initially I was only offered a TAH but for a variety of reasons including some emotional ones I researched and found that hysterectomies could be done for cancer diagnosis with the daVinci.



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Fire, I'm so looking forward to reclaiming life too! I have almost daily pain, and I do miss work the first day of my period, I'm in wretchen pain for a few days and it's just taken over everything since about October. Will be nice to be past all of this. And I also meant to say, I'm sorry to hear about the cancer diagnosis in your pooch My 3 dogs are my everything. Rescue is not what I do for a living, but I truly admire everyone that does. I've gotten all of my animals (5 total) from either rescues or from death row on the pound. Love my furry kids

Tauruslady, thank you TAH and LSH are the options he gave me, I guess a combination of his experience and my past. I will ask again about the vaginal assist and bring up daVinci...but also want him to do what he's most comfortable with too. I'm just really happy to put this behind me no matter how I get there. Thank you so much for your reply.

Hi Jill - Thanks for you good wishes about Jake-dog...it`s sad for sure.

SOON life will be back on track and no more missing out on work or anything fun! I hope you are feeling more confidant about your decision which every way you decide to go, and please keep us posted with whatever you want to share or still have questions about!

I had a TAH on 4/20 and have been comparing notes with those on the forum who had a LAVH. The recovery process is very different. Those who had the procedure vaginally are back to work already. For me, there's no way I'm ready to even think about that yet. In my opinion, I would say it's best to go the least invasive way possible.
Best wishes on your decision.

jillr331-
I understand you not wanting to keep your cervix. I am ditching mine. I figure in my body if something can go wrong it will eventually. So, what the hey, I figure do it once and do it right. I can understand how some women might want to to keep all the healthy parts, but I have been so sick my entire life I would love to switch bodies with almost anyone. I figure what is one more organ? Anyway, if you can do your surgery in a less invasive way than a TAH and still get the desired results then I would do it that way. Abdominal surgeries are the pits. (I have to have a TAH because my gyn wants to know what the spoot is going on inside me.)
I have two dogs (fur-people). 1 is a rescue and the other was a gift to "heart mend" me since my beloved lab/border collie passed away last July. The gift was a yellow lab. She is six months...Lol... All she wants to do is be active and all I can do is sit. Thankfully I have a great support network that walks her and plays fetch etc.
Good Luck~!

Jill -

Thought you also might find this pre-op article Hysterectomy planning - cervix to keep or not about some of the views on keeping the cervix.

It won't give you a definitive answer but may give you other things to think about and things to ask questions about.



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