LSH for large fibroids?

Hi Everyone,

This will be my first post, but I’ve been reading for a few days now. When I first came to this site, I thought I had done a lot of research, but I’ve learned more from the women here than any of the medical sites. Thank you for that!

For two months, I’ve endured blood tests and x-rays and scans (oh my!). The conclusion is that I have severe anemia caused by fibroids (the largest measuring about 10cm). My doctor said I have a grapefruit and a lemon and maybe a cherry or two in there – is that a jackpot?

We weren’t able to schedule surgery right away because of the anemia – it seems the anesthesiologist won’t come near me until I get my blood count higher. The doctor wanted to put me on Lupron, but I refused. (I had a nightmare experience with depo-provera a few years back, and I swore off anything that messes with my hormones from that day forward.) She told me the Lupron might allow me to have a vaginal procedure instead of abdominal; but I didn’t want to risk long-term brain damage (as my brain is one of the few organs I have that works properly most of the time).

It wasn’t until I started reading posts on this forum that I learned there was a third alternative – laproscopic surgery (LSH). After reading a dozen articles on the procedure, I called my doctor to ask why this wasn’t an option for me. (After all, they keep telling me the anemia is a big problem – so wouldn’t I be a candidate for a procedure that results in less blood loss?) The nurse’s assistant explained that my fibroids are too big for an LSH and since I refused the Lupron, I would have to do it abdominally. But isn’t that what the morcellator is for? (She’s going to pass on the request to the doctor, so fingers crossed.)

My question (finally!) is this: Has anyone had (or is anyone having) an LSH to remove large fibroids that weren’t shrunk with Lupron? When I talk to the doctor next week, I’d like to have as much information as possible (even if it’s anecdotal). At this point, if my doctor refuses to consider an LSH, then I’m planning to seek a second opinion. I love my GYN, but I don’t see any need to have the abdominal procedure if I can avoid it.

Sorry to ramble on so long, and thank you (in advance) for any information you can provide!

swingonastar99

Hi Swingonastart99,

Welcome aboard. You sound like another Sister here, who describes herself as having had a whole "fruit salad" of fibroids.

My doctor had gone to Germany for 6 months to get trained the laparoscopic-only hysts, and was willing to do mine that way if I wanted him to (two walnut/golfball-sized fibroids, no endo or other problems). But he strongly suggested that the TAH was the simplest, quickest (less time under anesthesia), and least complication-prone way to go. (And if there were any problems - nicked vessels, etc. they would be easier to see and easier to fix.) Said he'd leave the lap-hysts to young hot-dogs out to prove themselves. He said if I were a friend/family member asking his advice, he'd recommend a TAH. And he said "What's an extra week or so of recovery compared to your health over a lifetime?" Well, OK. So that's what we did.

It went very well. I was able to have it done with a spinal (not possible with laparoscopic surgery), and was released to do "anything I felt up to doing" at 4 weeks. All in all, not a bad experience at all.

The abdominal incision was about 5-1/2" long, very low, and never hurt very much (numb-ish, mostly). By comparison, the belly button incision from an earlier laparoscopic surgery *really* hurt, for weeks. I could wear jeans sooner after my hyst than after my lap. The lap left an uglier and more annoying scar, too. (I *used to* have an OK-looking belly button...)

I'm not trying to talk you out of the laparoscopic hyst. I'm sure most women who have them are happy with the results. Just don't put *too* much energy into avoiding the abdominal way, if that's really your best choice. It does sound like the incision would have to be terribly painful, but it's surprisingly not too bad.

Best of luck with your decision!

Thanks, HorseWoman, for the reassurance. I will, of course, discuss the options thoroughly with my doctor (and possibly one or two others).

I'm not worried about a scar or the pain really (though the complications I'd like to avoid). My concern is the recovery time. As much as I'd LOVE to spend a month at home, relaxing and being taken care of, I simply can't spare the time. I'm scheduled to do a presentation in Europe -- currently planned for the first week or two of November. That's 4-6 weeks after my tentative surgery date. And from what I've read, at 4-6 weeks post-TAH, most women are still pretty fatigued.

What that means is I either have to postpone surgery or potentially bow out of the presentation. I'd prefer not to do either.

By the way, I had a laproscopic tubal ligation a couple of years ago, and it was a breeze. I went to Hawaii a week later, and did 8 mile hikes and scuba diving.

You're right - I was feeling very good at 4 weeks, but still pretty easily wiped out. No way could I have been wandering around the planet. And it sure sounds like you have better luck with laps than I did, which is great.

I know there are other women here who've had LSHs - maybe you could search for them, and see how their recoveries went.

Is there a chance you could have the surgery sooner, to put more time between your surgery and your trip?

Whichever way you go, I hope it's uneventful, and that you have a great trip.

Ten years ago, I had a myomectomy for fibroids. My surgeon did not put me on lupron first because I didn't want to mess with hormones,. I went to the hospital for a one-day laporoscopy procedure, but when he started, he saw the fibroids were too big (the largest were obsured by my bladder on the ultrasounds). He sewed up my belly button (and yes, that took forever to heal and it hurt like heck), and sent me home. Three weeks or so later, I had a myomectomy via an abdominal incision (which healed very easily). Now I'm going in for a hysterectomy since the fibroids are back big time, and are totally messing up my life.

LSH

Hi,
I didn't have to deal with large fibroids but:
I had a LSH on May 22,
dr suggested it because my uterus wasn't too enlarged and had only one fibroid, I also had endo and adeno. Stayed in the hospital for 23 hours and incision healed ok.

Then I had a RSO laparoscopically on June 26 (two surgeries within a month) because of a burst corpus luteum cyst that was hemorrhaging. Incision was right on top of first one. Besides having had to go back to ER because of getting behind the pain (I left the hospital 3 hours after this second surgery), incision healed perfectly and discomfort has been minimal.

Since the incisions done for laparoscopic surgeries are small, doctors prefer them when there are no large cysts to deal with. I had 4 incisions, the smallest one the size of a pencil eraser and the largest on my navel 2 inches long.

Recovery time for lap surgeries are aprox. 3 weeks. I went back to work after 3 weeks.

Maybe due to your large fibroids it would be a wise choice to do it by other means.

Good luck to you,
Dasha

Hi Swingonastar99,

One of the newest total laparoscopic hysterectomy doctors brags about the size of the uterus he can remove. He uses the RUMI System Uterine Manipulator and the KOH Colpotomizer System for an enlarged uterus. Using this technique he says the uterus can be up to 24 weeks in size or 1500 g.

This RUMI and KOH are to enhance visualization. He can also move the uterus laterally to expose the vessels. He also claims with practice...to get this surgery down to 60 mins! The average doctor is not trained on this new procedure.

This is the only procedure that I have read about for a larger uterus. I think it comes down to who is trained in what, and the risk each hospital wants to take.

There obviously must be a cut off size for the morcellator...I just don't know it. You've got to find this out before your appointment.

Best of luck with your research and next doctor's visit.

Hi,

I had a 10cm fibroid -- although I was put on Lupron to stop bleeding (I had a 3 month HEAVY period complete with clots), doc wanted to do a TAH because I have never had children and my uterus was tilted.

Came through with flying colors!

Just my

s

Hi Swingonastar!

I am just a little over 2 weeks post op from my LSH. My uterus was huge I looked at least 6-7 months pregnant, I had several "softball" size fibroids, as well as a cyst on my tube and severe adhesions, pain everywhere, out of control periods, life altering situation. I wasn't about to take Lupron to shrink them, nor was I asked to. I hate any kind of drug.

Tried desparately to avoid a hysterectomy, now I am wondering why. I am feeling almost back to normal, no pain post-op, went home in less than 24 hours, was able to do work on the computer, phone etc, within a couple of days. Took a carfull of kids to the midstate fair before I was even 2 weeks, saw a concert, I am able to drive, bathe, no restrictions (per the doctor), I have been able to go pretty much back to life as before.

This was just my individual healing process, yours may be different, I would certainly be able to make an overseas trip in a month, but you do want to be careful and totally baby yourself as much as you feel necessary and then some. By the way, I was too ill before my surgery to do any kind of exercise, so I truly don't attribute my recovery to any pre-op conditioning. I believe the key to the success was finding a truly skilled surgeon. I was fortunate enough to find one through a friend of mine who is a surgical nurse. He came through as promised, I wanted to save my ovaries and cervix (my personal desire) and he was okay with that. My incisions are tiny, can't even see the largest one that was done in my navel at all. I did not request this type of procedure, it was just the one this doctor recommended for me, due to the location and size of my fibroids and uterus, he didn't say anything like I was too big to do a vaginal, but I suspect I was. I truly encouraged him to use a regular incision since I have had several surgeries and couldn't care less about scars, he didn't feel in was necessary. He felt this surgery was easier on the patient.

So far so good, or should I say "too good"!

LSH 7/19

Hello,

I am still pre op so I don't really talk from experience. My date is 8/13 but anyway, I am scheduled to have a lavh/bso and she said 6-8 weeks from work. Because even if the incision heals perfectly right away, alot of women fatigue easy until the hormones are right. Just my two cents. Let us know what happens.

Vicky
endo, adhesions, fibroids.
scheduled 8/13/02
LAVH/BSO