How is the type of hysterectomy determined?

I must say that everybody that is waiting or has had their surgery should know about this incredible site!!
After reading,I'm sure hundreds of posts I have made an obvious observation,and my question is this-When a woman and her dr have decided that a hysterectomy is the next option,how is it decided as to what type is going to get done? I realize that certain factors help in determining which way to go however I have noticed that the healing process and restrictions differ considerably between the different options.The vertical and bikini incision have me curious also.Why one over the other?
I would love to hear from some of you because my dr told me I could not have a lavh because I had a small fibriod.
Now after spending alot of time on this site I'm reading that women with fibroids did get their surgery done vaginally.
Laurie

Yes, women with fibroids do have vaginal hysterectomies; exactly the case for a friend of mine. But is LSH an option for you? Is it available in your area? (LSH requires special training and is usually available in larger cities). This is also an option that, if you're a candidate, you should consider. My doctor offered it first thing when we decided that a hyst was the best thing to do. She knew I didn't want a long recovery and it's worked very, very well for me.

Hey Coonkat! I actually had my surgery done on Jan 16th.I had a TAH keeping my ovaries.After spending alot of time on the site I realised that there are different options and wondered why some women had one type over the other.You have a great point when saying larger cities have more medical options.Timmins Ontario,Canada-population 45,000 !!! However Im feeling great.

I was so naive about the whole process that I just went along with whatever the doctor said. When he gave me my options for treating endo, I refused the drug therapy and told him I wanted the hysterectomy. He said okay and then he told me he was going to do a LSH. I didn't have a clue. But I'm glad that he could do this type of surgery. It was a much easier recovery. Also he said that this is the main type of surgery he does these days.

My doctor did abdominal because of the risk of cancer cells spreading when the uterus is cut up to remove it vaginally. I also had a small fibroid and multiple polyps.

I had my TAH on 2/8/07 and am doing very well. Minimal discomfort even with the large bikini cut incision.

Hi Ladies,

My doctor did my TAH bikini cut because I already had a bikini cut from a myocmectomy 3 years ago to remove 2 large fibroids. 3 years ago I asked my doc why couldn't we do it another way? My doc said because my fibroids were at the top of my uterus and he couldn't get to them otherwise.

This time the doc wanted me to do Lupron from the pain I had from my mulpile fibroids. I said no, do the hyst. I knew that I would have to have a hyst eventually, lets just do it now so I don't have to think about them growing.

Maureen

Lots of things are taken into consideration. Cancer possibility. Scar tissue. Location/position of growths. In my case I had a polyp or cyst on my cervix, and to go in the other way they were afraid would produce too much bleeding. Also the fact that my cervix is very high up making it difficult to get to things to even look, much less do anything. My past c-sections and the scar from those was another factor in it. So was my weight. So I had a TAH.

That's the thing. I know one contraindication to LSH is cancer. Another is a very enlarged uterus. Not because they can't remove it (or large fibroids, they definitely *can*) but because if the uterus is too large, they can't see the blood supply to safely operate. I was lucky in that my endo, while pretty nasty, adhered only to my bladder and left ovary (which was removed for the cyst anyway). Had the endo also been on my bowel, they'd probably have to have converted to abdominal. According to my doctor, there's a 10% chance of the necessity to convert; then I realized that meant a 90% chance I'd still come through with LSH. Also, doctors do what they know. This isn't a bad thing. If the facilities/trained surgeons aren't available nearby, they do the thing they do best and safest.

So don't get me wrong: no one who has any other method is "wrong". I just wish LSH (and its variations thereof) were more known and available to more women, because based on my experience, and compared to what I've read on this site, it was really quite easy, given that it's a major surgery.

My doctor did not have the option of a vaginal surgery. My uterus was too enlarged in addition to the fibroids.

He and I discussed the various options on the overies. He told me that the final decision was to be decided by me, but he preferred to take everything because he had heard too many stories of women developing undectable ovarian cancer. He explained that there is no method to detect oviarian cancer post hysterectomy, so it usually isn't detected until the patient is in stage four. That was enough information for me.

My uterus was roughly the size of a grapefruit due to a fibroid on the back side. My doctor said that I was near the borderline for having a successful vaginal hysterectomy done. I knew beforehand that there was a chance that the surgery could convert so I wasn't sure what I would have when I woke up. She was able to perform the procedure by cutting the uterus into pieces and removing it. I'm not sure of the exact details but I am so glad she didn't have to make any external incisions. I have had previous abdominal surgery and the recovery from this was not bad - just some mild cramping, little to no bleeding (just some light discharge). Best of luck to you.