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Second and Third Opinion?
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HysterSisters recommends that you get more than one opinion when your doctor suggests a hysterectomy. You may have a trustful long-standing history with your doctor and feel horrified that we suggest such a thing! This isn't a slap in the face for your personal physician but a smart thing for every patient to do.
Set up an appointment with a different surgeon in a different practice and even perhaps in a different town. Take your records with you but also ask for an exam. Ask if the first recommendation is appropriate. Ask for alternative suggestions.
Get a third opinion. You might find the third suggests an even less invasive solution.
Consider these points:
Have I tried all the alternative treatments?
Are my symptoms so unbearable as to make my life a misery?
Will the operation relieve all my symptoms?
Will there be any unexpected consequences - am I prepared for an earlier menopause?
Do I still want to have children?
What will happen if I decide not to have a hysterectomy?
The key is for you, the patient, to get all the information you can before you agree to surgery. You cannot change your mind once the surgery is done. There are no money back guarantees if the surgery is not the cure for your problem. Be smart. Do your homework.
HysterSisters always suggests that a hysterectomy is your last resort after you have explored all other options and treatments. Be well!
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Kinds of Hysterectomy
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Total Abdominal Hysterectomy
The cervix is part of the uterus, together they form the whole. Therefore a total hysterectomy is removal of both uterus and cervix.
Acronym: TAH
Description of procedure:
The doctor makes a cut in the abdominal wall to expose the ligaments and blood vessels around the uterus. The muscles in the abdomen are usually not cut, but spread apart with retractors. The ligaments and blood vessels are separated from the uterus and the blood vessels tied off so they will heal and not bleed. Then, the uterus with the cervix, is removed by cutting it off at the top of the vagina. The top of the vagina is repaired by being sewn so that a hole is not left. This is called the vaginal cuff.
Indications/contra-indications:
This is the best option for you if you are dealing with the possibility of cancer, have large fibroids, or have never delivered a baby vaginally.
It is the most invasive of the surgery types and the one that may involve the longest recovery. There is risk of the incision becoming infected.
Initial Recovery:
Expect 6 to 8 weeks of recovery, with lifting and straining restrictions for this whole period. It is also normal to have a restriction on intercourse for the whole of the initial recovery period.
Variations on a theme:
It is possible your doctor will do a Supra-cervical Abdominal Hysterectomy (SAH), which means that only the main part of the uterus is removed, and the cervix is left in place. In this case, if you also retained your ovaries, you may experience mini periods.
Total Vaginal Hysterectomy
This procedure is the same as for the TAH, except it is performed vaginally.
Acronym: TVH
Description of procedure:
The doctor removes the uterus and cervix through a cut in the vagina. As with the TAH the top of the vagina is repaired by being sewn to form the vaginal cuff.
Indications/contra-indications:
This is usually the surgery of choice if you have prolapse, if there is no possibility of cancer, if your uterus is not too enlarged and if you've delivered vaginally.
This type of surgery is not recommended when the surgeon needs to have space to look around, if there is danger of cancer cells or of endometriosis spreading, if your uterus is enlarged beyond a certain size and sometimes if you haven't delivered vaginally. This surgery can entail additional bleeding. Because you don't have an abdominal incision, it is easy to forget you've just had major surgery and you run the risk of thinking that you are further ahead in your recovery than you really are.
Initial Recovery:
Expect 6 to 8 weeks of recovery, with lifting and straining restrictions for this whole period. It is also normal to have restrictions on intercourse for the whole of the initial recovery period.
Variations on a theme:
It is possible that your doctor will opt to perform a Lapararoscoply Assisted Vaginal Hysterectomy (LAVH). If that is the case, the cervix is still removed.
Laparoscopically Assisted Vaginal Hysterectomy
Acronym: LAVH
Description of procedure:
During a LAVH, several small cuts are made in the abdominal wall through which slender metal tubes called "trocars" are inserted providing access for a laparoscope and other small surgical instruments. The laparoscope is like a tiny telescope with a camera attached to it that provides a continuous image which is enlarged and projected onto a television screen.
Just like in a TAH or TVH, the uterus (including the cervix) is detached from the ligaments that attach it to other structures in the pelvis, and removed through a cut at the top of the vagina which is repaired with stitches.
Indications/contra-indications:
Not all women are candidates for laparoscopic hysterectomies and the decision to use this method must be made on an individual basis.
Initial Recovery:
Expect 4 to 6 weeks of recovery, with some lifting and straining restrictions that could extend beyond this period. You can expect to have restrictions on sexual activity for most or even all of this initial recovery phase.
Variations on a theme:
It is also possible that your doctor will perform a Total Laparascopic Hysterectomy. In this case, the surgery will still be performed entirely laparascopically, but the cervix will be removed.
Another possibility is that your doctor will opt to perform a Laparoscopic Supracervical Hysterectomy (LSH). If that is the case, the cervix will be retained.
Laparoscopic Supracervical Hysterectomy
This procedure is done completely laparoscopically and does not remove the cervix.
Acronym: LSH
Description of procedure:
The uterus is cut up into small pieces and removed through the tubes which were inserted into the abdomen.
Indications/contra-indications:
Not all women are candidates for laparoscopic hysterectomies and the decision to use this method must be made on an individual basis.
Initial Recovery:
Expect 2 to 4 weeks of recovery, with some lifting and straining restrictions that could extend beyond this period. You may have restrictions on sexual activity for this initial recovery phase.
Variations on a theme:
It is also possible that your doctor will perform a Total Laparoscopic Hysterectomy. In this case, the surgery will still be performed entirely laparoscopically, but the cervix will be removed.
da Vinci® Hysterectomy
Uterus removed using the least invasive procedure otherwise known as robotic surgery.
Acronym: dVH (da Vinci Hyst) or RALH (Robotic Assisted Lap Hyst)
Description of procedure:
The surgeon uses da Vinci® surgical equipment to remove uterus, tubes, ovaries, lymph nodes (as indicated by medical need) through 5 small incisions: one directly below navel, two on right, two on left.
Indications/contra-indications:
This is an excellent option for you if you have access to a practiced da Vinci surgeon. Patient's weight, diagnosis, size of uterus does not seem to alter possibility of this surgery option.
Initial Recovery:
Expect 3 to 4 weeks of recovery, with lifting and straining restrictions for this whole period. It is also normal to have a restriction on intercourse for the whole of the initial recovery period. Note: this is half the recovery time of typical abdominal surgery.
Variations on a theme:
If cancer is a possibility, this surgery is still an option as the robotic equipment provides for an excellent visualization and capacity working in confined areas to remove lymph nodes for radical hysterectomy. Patients with a history of adhesions may also find da Vinci hysterectomy a good option.
Bilateral Salpingo oophorectomy
This involves the removal of both ovaries and of both fallopian tubes.
Acronym: BSO
Description of procedure:
Sometimes, both ovaries and fallopian tubes are removed at the same time a hysterectomy is done. When both ovaries and both tubes are removed, it is called a bilateral salpingo-oophorectomy which is usually shortened to BSO. (bilateral=both sides, salpingo =the fallopian tubes, oophore =the ovaries, ectomy = removal)
Indications/contra-indications:
The removal of ovaries is most often recommended when the ovaries are diseased. Your doctor may also recommend their removal in the case of cancers that are responsive to the hormones produced by the ovaries. If Endometriosis or Adenomyosis is suspected, some doctors will suggest the removal of ovaries.
Removal of ovaries will put you into surgical menopause which may result in hormonal imbalance and might put you at an increased risk for heart disease, some types of breast cancers and could trigger clotting disorders.
Initial Recovery:
Your recovery will be based on the type of hysterectomy you had.
Variations on a theme:
Sometimes only the left or right ovary & tube are removed, and this is referred to as RSO or LSO
Anterior and Posterior Repair
This involves repairing the vaginal wall in order to either correct existing prolapses or to prevent further prolapses.
Acronym: A&P Repair
Description of procedure:
Indications/contra-indications:
These repairs are usually only done when the vaginal wall has either been damaged or atrophied. These repairs are usually accompanied with extra stitches and tightening of the vaginal area in order to strengthen the area. This may cause problems during penetration but will also prevent further prolapses.
Initial Recovery:
Initial recovery is the same as for a TVH or TAH. Lifting and straining restrictions are usually prolonged for several weeks after the 6 to 8 weeks initial repair. There is often a permanent weight restriction for lifting as once you've had a prolapse you are vulnerable to further prolapses.
Variations on a theme:
Sometimes there is only a need for Anterior repairs or for Posterior repairs.
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Keep Your Ovaries and/or Cervix?
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It seems it wasn't too long ago that when a doctor recommended a hysterectomy, the removal of cervix and ovaries were assumed to be part of the surgery. Today you may have options and decisions to make about keeping your ovaries and cervix.
If your ovaries are healthy, you may be in better shape, now and 20 years from now, by keeping them. It isn't always easy for HRT to duplicate the hormones produced by the ovaries. This is not a decision to be taken lightly or for the convenience of avoiding future surgery. If you need your ovaries removed later, it's a much less serious procedure--and you will have had that extra amount of time with your original equipment.
Many women are finding that keeping the cervix may have added benefits if it's healthy and there haven't been abnormal pap smears or disease. The cervix helps support the pelvic floor, is the source for some types of orgasm and may provide other benefits as well.
Talk frankly with your surgeon and discuss your concerns. HysterSisters suggests keeping healthy organs if possible! Take your time and explore all your options. Be informed and make your decision based on what is right for you with the help of your surgeon.
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Questions to Ask At Your Pre-Op Appointment
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1. How long will surgery take?
2. Exactly what will be removed? Uterus, ovaries, tubes, cervix, appendix? (How will these organs be removed? Through abdominal incision? Through the vagina? With the help of a laparoscope?
3. How long will I be in the hospital?
4. How long will I be on bed rest?
5. Will a pathology report be done of all the organs removed? I do want one done.
6. How long for the results of the pathology report to come in? (If cancer is suspected, when will I begin cancer treatments and what options are there?)
7. If I'm taking BC pills or HRT, do I stop taking them prior to surgery? If so, how long before?
8. What medication will I be on for pain in the hospital and when I am home?
9. Will the doctor make a bladder tack? What is a bladder tack? (If you have incontinence, this is the time to bring it up as this is the best time for bladder and/or rectum repair)
10. Will the doctor use a tummy binder on me? Will I need one?
11. If my ovaries are being removed, when will I start hormones (HRT)? Most important: will the doctor help me to adjust if needed or should I see my family doctor to help with this?
12. If I am keeping my ovaries, how will I know if they are working post-op? if they shut down temporarily and I experience hot flashes, how long will I endure menopause symptoms before the ovaries kick back in?
13. Will I need any preparation before surgery? (enema, stool softener, liquid diet, etc)
14. When will I be able to resume driving?
15. How long will I be off work?
16. Will I be able to lift my baby? If not, how much can I lift safely at 4 weeks, at 6 weeks?
17. When can I return to the gym?
18. I take certain meds regularly (list your meds, including over-the-counter meds and supplements), will I be allowed to take these to the hospital with me?
19. I've heard that there is a problem with gas after surgery and have been told that Over-the-Counter medicines such as Gas-X can help. Is it OK if I take some along to the hospital with me?
20. What kind of anesthesia will I have?
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Prepare For Your Surgery
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During your pre-op appointment you will probably be given instructions on how to prepare for your surgery. It's important to keep those instructions handy and refer to them as the date gets nearer.
Every surgeon handles pre-surgery preparation differently. Be sure to follow your doctor's instructions. If these instructions do not include bowel-prep (enema and bowel clean-out) do not give yourself any treatment without specifically asking your surgeon.
Generally speaking, you should eat light meals during the 24 hours before surgery and you must stop eating and drinking within 12 hours of your scheduled surgery. Do not take any medication that you have not specifically informed your hospital and surgeon about. This includes supplements and herbs.
Nail polish removal is usually requested prior to surgery - fingers and toes.
Do not shave your pubic area unless you have been told to do so. Most doctors and hospitals have their own procedures and generally do NOT want patients shaving themselves.
If in doubt about the preparation instructions, call your hospital or doctor's office and ask them. Your surgery could be cancelled because you failed to follow instructions.
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What do I Pack For the Hospital?
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- slippers
- your own night shirt/sleepwear
- oversize cotton panties
- pads
- toothbrush and toothpaste
- shampoo and conditioner
- comb/brush
- facial cleanser
- deodorant/antiperspirant
- lightweight cotton robe
- lotion
- backscratcher
- lip balm
- Phone Calling Card or your cell phone (check hospital policy)
- Tummy Pillow!!
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Prepare Your Recovery Room
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You will be spending a lot of time the first few days, maybe a week or two, in your bedroom or on the couch. These areas need to start off clean and organized. There is no need for a special hospital bed but you could be on the look-out for a rolling cart to put next to your bed for magazines, water, and a book or two.
A few days before surgery, get the room where you will be sleeping cleaned with fresh sheets on the bed. Clean off the nightstand to make room for items you will need: a lamp, the phone, the remote control, room enough for glass of water or juice. Extra pillows are a good idea.
If you are forced to be more independent because you won't have help getting in and out of bed, you might want to consider putting a kitchen chair by your bed and using it like a bed rail.
The main thing is convenience for you and making things as easy as possible. Plan ahead!
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