TVH: TVH vs TLH

So I had my pre-op appt yesterday and my surgeon told me he has decided to do TVH. He had previously told me he was doing TLH and that was what I had been mentally prepared for. Now I am really scared.
A little background. I was diagnosed in Jul with multiple blood clots in my lungs. I was rushed to a trauma center and put on IV blood thinners. Two weeks later I got my period. No big deal right? WRONG!! I couldn't stand up without losing massive amounts of blood. My periods had been heavy since I delivered my twins but nothing like this. So I went to the ER and was admitted. They found several fibroids. I had a blood transfusion, was given a Lupron injection and had a Mirena IUD placed. After 4 days I went home. Then the IUD dislodged. So the plan was hysterectomy at my request, but I needed to be on my blood thinners for 6 months. In the meantime I was taking Lupron injections for medically induced menopause.
Surgery is this Friday. Need to know which procedure is better. And what I would need to do to prep for a TVH. Is it too late to change my mind about the approach? Or is it even my choice to change the approach?

I am so sorry for all you have gone through. No wonder you are nervous!

While you have say in the hysterectomy type, the final decision will be made by the surgeon based on medical experience. It's your body, but you are asking another body to do the work and ethnically they have to do what they believe is best for the patient. If you don't agree with the surgeon, you can seek a second opinion--which you should do before any major surgery. Another surgeon could have different training and experience that would cause him to make a different decision.

I can think of a few reasons why your surgeon may be thinking the total vaginal hysterectomy is the best choice between the two options. When everything is straight forward, the vaginal hysterectomy is still recommended by the ACOG based on a few different studies. Vaginal hysterectomy is faster which can be important in your case. A lap hysterectomy takes longer in the OR and the patient is under anesthesia longer. Your surgeon may think it is best to have you in and out of surgery as quickly as possible. After surgery, there is also less risk of the vaginal cuff tearing after a vaginal hysterectomy vs a total lap hysterectomy, something else that could be an issue with you because of the blood thinners. If it tears and you bleed, that could be a significant problem for you. A vaginal hysterectomy is cheaper, too, if cost is an issue in your case.

Have you asked your doctor about why he is going with one method over the other? He would be the best one to explain why he feels that a vaginal hysterectomy is the best choice for you. Since you have questions, I suggest you give your surgeon a call. You shouldn't go into OR with unanswered questions.

Look, I'm a huge proponent of saying "it's your body", but with your unusual and higher risk circumstances, I think your doctor is making an informed medical decision that will be better for your situation. A TVH involves no cutting outside the body, so he probably is doing is to lessen the surgical risk.

You could always seek a second opinion, and if you are having doubts, you should. If you do, bring all your medical records and make sure the new doctor is completely aware of your history.

I can't advise you, but it does sound like your doctor has thoroughly studied your case and is making their best decision for you.