Laparoscopy vs. Laparotomy?

Hello!
I am having surgery to remove a 5 cm complex cyst contained within my ovary. (Ovary will be removed). They are letting me choose laparoscopy OR mini-laparotomy (3 inch incision at bikini line).
I also can choose general anesthesia or spinal for the mini-lap.
PLEASE HELP ME FIGURE THIS OUT!
I guess complication rates are the same. It comes down to preference.
I have a gyn/onc who is very skilled, and I have a history of a borderline tumor being removed from the left ovary almost 2 years ago. So part of the surgery will be looking around to make sure everything looks OK.
Any opinions on the two surgeries?
Thank you!!!!

Like you, I was given choices ("door number one or door number two?") and I didn't feel like I received enough information to make an informed, intelligent decision. I ended up making appointments with two trusted family practice docs (besides my surgeon) in order to ask questions and get advice. Each doctor gave me different advice, but at least I felt more informed when it came to decision time. My choices were different than yours...vaginal hyst or laparatomy, and I eventually chose the laparatomy. My tumor was too large to be removed by laparoscopy.

As for the anesthesia question, I too, was given the choice of general or spinal. On the day of surgery, the anesthesiologist presented both choices, but in so doing, he clearly favored using a spinal. When I showed up at the hospital, I intended to chose a general (wake me up when it's over!), but after listening to the anesthesiologist, I went with a spinal. I'm very happy with that choice. I didn't wake up groggy and had no incision pain for several hours after the surgery. In addition to the spinal, they give you a "light" anesthesia through an IV. I don't remember anything about the surgery. It was as if I was completely out, and the upside is that they don't have to intubate you with a spinal. Even though I don't remember anything about the surgery, my surgeon told me that I was cracking jokes and talking throughout. Go figure!

Best wishes with your surgery and the pre-surgery decision making. Does your surgeon think that he/she will be able to "look around" any better with the laparotomy as compared with the laparoscopy?

Karen

Karen, THANK YOU for writing me! Everyone thinks I am crazy to prefer spinal. I had a c-section and it was OK, so I prefer spinal and a mini-laparotomy, and I was given the choice. EVERYONE says I am crazy and I should choose laparoscopy and General. I am afraid of General and would only do it if spinal were unsafe. Can you give me more thoughts on this? You are the only one I've found who says to have the spinal!
I think everything is even regarding looking around. The surgeon said the complication rate is the same, but recovery would be longer (more tissue damage at incison) with the mini-laparotomy (which is just a smaller 3 inch incision at the bikini line).
I have to decide, and it is driving me crazy trying to make the "right choice".
How fast did your legs come back? How was the recovery?
THANK YOU FOR ANSWERING ME!

Like you, I was worried about not being able to move my legs after the surgery. I thought it would be a very disconcerting experience. Turns out it wasn't stressful at all. The nurses come in regularly and ask you to wiggle toes and before long they report that things are moving. The upside to the immobility is that the spinal wears off from the toes and works its way up the body, so there's no pain in your incision site for many hours.

As far as the recovery goes...I talked with other gals who had experienced c-sections (I haven't) and some of them scared me to death. I was told that I wouldn't be able to walk up stairs (and warned that I'd have to sleep on the couch for a week). I was told that I wouldn't be able to get on and off the toilet by myself (I'm the single mom of three sons and I was worried that my boys would have to haul me off the toilet). Turns out that all those worries were over nothing! My incision is about 5 inches in length. I was able to get on and off the potty from the start, stairs were no problem, and the discomfort was tolerable. I was sent home with Vicodin and Ibuprofin. I took the vicodin for the first four days and then switched to Ibuprofin. I haven't taken any of that for the past week. I walk (slowly) every day, started driving at 10 days, and feel like this recovery has gone very well (for a 50 year old).

You have already experienced a c-section and have so much history to draw on in terms of the recovery. The biggest challenges for me were getting in and out of bed during the first 10 days (not the easiest thing to do...especially when I had to get up a couple of times in the night) and figuring out how to pick something up that I dropped on the floor. The floor seemed like a very long way down when I couldn't bend very well.

When is your surgery? I pray that you will have confidence in the decisions you make, that your medical team will provide you with the best of care, and that your family will take good care of you when you return home. You will feel a sense of relief when the surgery is over and you can focus on healing instead of worrying.

Karen

I was reflecting on your "everyone thinks I'm crazy" comment. I was given the choice of a vaginal hyst or a laparatomy to remove my ovary. People thought I was crazy to chose the laparotomy over the vaginal hyst. Many, many people told me to chose the hyst since "you're 50 years old, why do you need a uterus anyhow?" Even though the recovery from a laparatomy is more difficult, it made no sense to me to remove a healthy cervix and uterus just to get at my bad boy ovary. My doctor told me that many women come in begging to have their uterus removed, and here I was crying and saying I didn't want them to take it. We had a good laugh over it. What the doctors told me (all three of them) is that from a medical stand point, either decision is medically sound (which is your situation as well). The other factors that go into the decision (your concerns about general anesthesia; my desire to keep my uterus) are subjective, but real. No one has the right to pressure you about the decision and you will know when you have made a decision that is right for you. All the best!

Karen

OptimisticMe,
I had my TAH in January '05 and RSO (by laparotomy) in November '05 done using an epidural. For the me I was afraid of being put to sleep. As the anestheisiologist told me ... "You are the type that doesn't like to lose control !!" I said you are right !!! I had 4 c-sections using the epidural and they worked wonderfully with mininal pain. I choose to keep the epidural drip for 24 hours after surgery. The next morning when the pump was turned off I started my pain meds and was up moving around the room later that morning. With the TAH, I was given versed and fentanyl and I don't remember a thing about the surgery. With the RSO, I told them I didn't want anything and was wide awake for the entire procedure. The surgery lasted 1 1/2 hours due to adhesions that had to be removed along with the ovary. If I had to do it all over again I wouldn't change a thing.
Best wishes with your surgery,
Nancy

Nancy and Karen,

You two were sent from God. Honestly, not being overly religious, I got on my knees and asked for guidance, and your emails popped up soon thereafter.

This has been such a difficult decision for me. I can't explain it, I want so bad to do what is "right" that the choice has made me paralyzed.

I have gone in the last six weeks from believing I had cancer (MRI said mass in ovary was suspicious for malignancy) to not fearing cancer (My surgeon is convinced it is benign) but fearing the laparoscopy and general anesthesia. It is like my gut is telling me NOT to do it, yet everyone, and I do mean EVERYONE is telling me to do it.

I am thrilled that my surgeon gave me the choice, and truly said the complication rate is the same, and it is completely up to me.

Yet I've been told that it could be dangerous and unsafe by some, with the spinal, becaues the surgeon wouldn't be able to look around at the organs for evidence of cancer, etc. But how can that be true if she gave me the choice, and you two had pretty much similar if not more invasive surgeries than I had, I am having a mini-laparotomy (3 inch incision) and the right ovary and tube removed, then the look around, assessment of left ovary, and a "washing".

Just knowing you did this with a spinal and epidural, makes me thrilled! Believe me, I am not excited about the spinal either, and I shook a lot during surgery (shaking like I'm cold, did you guys have that?) and I took an unusually long time to regain the feeling in my legs, and I hated the catheter, and the IV, and the whole things is NOT FUN, but I have to have it done, and if I do, I just really want the mini-laparotomy and spinal . . .and finally I got validation that it is going to be OK.

I love you both, and don't even know you.

BUT I LOVE YOU!

I will post again when I have recovered some and I am thrilled you are both doing well. I would love to know more, the good and the bad if you want to give me more advice.

I have surgery very early Tuesday morning, but I'll check this site again Monday night!

Just wanted to add, thank you for the good thoughts and prayers!

Now I'm wondering, epidural or spinal?

Any advice?

Also, there do not seem to be any real complications of spinal, right? I mean, isn't it really very safe?

Thanks again! I need to get to bed! And stop obsessing!

With the spinal the anesthesiologist injects the med and removes the needle. No catheter is left in. So if the surgery takes longer than 1-2 hours the medication could wear off. With an epidural, a catheter is left in the epidural space and medication can be administered throughout the procedure. With the spinal there is an increased risk of spinal headache but it is rare. (I'm a maternal/child nurse, and at our hospital they use spinals alot for c-sections because they work faster and are easier to perform for the docs. Epidurals are used for the vag deliveries or for c-sections if the patient request.)
Best wishes for a speedy recovery,
Nancy