Upcoming January hysterectomy: 2 hour abdominal VS 4 hour laparoscopic?

Wondering which is “better” if my goal is to have a safer surgery with lower risk of major complications. My goal is not necessarily to heal quickly. I have the time and support to take longer to heal from an abdominal surgery.

My surgeon estimated the times based on what she saw and felt in a pelvic exam, pelvic ultrasound and abdomen CT scan. The fibroids are growing right up against my colon, bladder, and ureter. And by growing up against I mean they are squishing those parts as well as taking up a lot of room. There is a chance if I choose laparoscopic they’d have to switch to abdominal anyway.

She said if I had the time to heal I should consider the abdominal surgery because it would be so much shorter. My question is why does it matter? Are there more risks with being under anesthesia for 4 hours vs 2?

Thanks for your thoughts and insights!

Moon_gal

Hi Moon_gal -

I cannot answer your question regarding being under longer creating higher risks. Your doctor probably can, given your condition. She may be implying this with saying that it would be a shorter surgery. It may also be easier for her to do the surgery if it was open abdominal.

I had a TAH BSO (total abdominal hysterectomy with both ovaries and tubes removed). I had a 6-inch vertical incision. My surgery was about 90 minutes. Plus, I had both general anesthetic and an epidural. My anesthesiologist recommended this combination because she could use less anesthetic that way and I would wake up quicker. I liked the sound of that.

Having a hysterectomy is MAJOR SURGERY. No matter the type, you will still have much internal healing to do. You really need to think in terms of weeks and not days. You will need help with cooking, cleaning, dishes, laundry, shopping, driving, etc. Here are articles that may help:
Hysterectomy Recovery Time
Hysterectomy Recovery Tips
Too Much Too Soon After Hysterectomy?

Make the best decision for you regarding your surgery type.

My doctor said similar things to me. She told me early on that laproscopic surgery was pretty much off the table unless we could shrink the fibroids and also said there was a good chance that she would have to switch to abdominal if she did attempt it.

At my last visit they were even larger and I was told that she felt it would be far too risky to even try laproscopically, because even if she could manage it I would be under anesthesia much longer. So if it were me, I would be sure to find out if your doctor is uncomfortable with your particular surgery being laproscopic. They know your case and their skills. Your safety should always be the most important consideration. Good luck!

and greetings from a fellow fibroid sister!
I would suggest that you get a second opinion on this, preferably from an OB/GYN who specializes in treating fibroids, like the one who did my surgery. My uterus was the size of a 22 week pregnancy, and my largest fibroid was pressing on my bladder, squishing it out of shape; I had two monthly shots of Lupron, which shrank my uterus to 16 weeks, and I was able to have my surgery done laparoscopically. Many surgeons don't have the specialized training for this, especially in cases like yours, and will default to an abdominal procedure, simply because that's what they're most comfortable doing. If getting a second opinion increases your chances of qualifying for a laparoscopic procedure, that would mean a shorter, less complicated surgery - I was under anesthesia for a total of 3 hours - and a smoother recovery, so I think that it's worth looking into. Best wishes for whatever you decide!

I also had a very large fibroid distorting the anatomy. I had a vertical 7inch incision due to the size. Abdominal comes with a longer recovery but my recovery went very well. I have full short term disability through work so was not concerned with that. I took the time to heal properly and was fine to return to my physical job 6 weeks post op. My recovery was basically pain free and I had no complications.I think I was under anesthesia about 2 hours. Discuss all options with your doctor and know whatever you decide it will be fine.

Another member of the "happy TAH" club here. :-) My surgery was for endometrial cancer and my doc said that a TAH with a vertical incision would give him the most room to look around for signs that the cancer had spread. You can bet I said yes to that!

I have no idea how long my surgery was. The last thing I remember is getting ready to go into the OR just before noon. The next thing I remember is waking up tucked into my hospital bed at about 7:30 PM.

I ended up with a 7" incision closed by 38 staples. I jokingly referred to it as "Frankenbelly."

I live alone, so for me, one of the benefits of having abdominal surgery was that it came with a three-day hospital stay. By the third day, I was confident of my ability to manage on my own. I was walking multiple laps around the ward and sitting upright in an armchair reading when I wasn't walking. I returned to bed only to nap/sleep. I was also off narcotics - I took ibuprofen for a couple of weeks - and eating solid food. I was sore and twingey, but I never had any "real" pain.

Recovery was long but easy. I did only the most minimal stuff necessary to take care of myself and my cats. Most of my time I spent walking and sitting outside reading and sewing. I went back to work at a part-time desk job at four weeks with restrictions on lifting. All my restrictions were cleared at six weeks, with instructions to start off cautiously and work up gradually. By eight weeks my body was performing "normally" except for some abdominal swelling that lasted another month.

Longer time under anaesthesia always increases risk but the question is how much is the increase. For me personally, the shorter healing time of the lap was well worth any slightly elevated risk from being under longer. I noticed in my surgery group that those that had abdominal surgery definitely had more extended healing and more downtime than the lap ladies

Great discussion. I appreciate all of your comments.

At this point I’m leaning towards at least trying laparascopic. My surgeon has done over 100 of them and is recommended by a gynecological cancer surgeon I know personally. And who is also rated nationally as a top doctor. I also got a second opinion and that surgeon said exact same thing as - my surgery will be tricky to do bc of how/where the fibroids are growing. Both seemed confident if it was at all possible they could do it.

And I’m doing acupuncture and Chinese herbs for symptom relief until surgery. Also hoping it helps the fibroids not to grow.

I also found out today my insurance out of pocket max is going up from $4000 to $7000 in 2019. My surgeon kindly agreed to do my surgery on Dec 28 instead of Jan 11 to help save $$$! So far I’m getting great pre-op support all around. Ask for what you need!

Thanks for your support and best wishes to those of you with surgery coming up soon!

I had tah due to large fibroids and enlarged uterus. I was disappointed at first, but I have to say that I felt really good after the surgery, and had a very easy recovery, much easier than many who had less invasive procedures. I don’t regret it at all, and have to think that less time under anesthesia must be better.

I’m glad to know if this ends up being abdominal it can still be good. I have a friend who had an abdominal myomectomy for a very large fibroid and her recovery was long and difficult. Her pain was not well managed even while she was in the hospital. And she couldn’t drive for about 4 weeks. And didn’t feel good for 12 weeks. Of course there are many, many variables and each person will heal in their own way at their own pace.

My surgeon expects I should be able to resume most activities in 4 weeks, regardless of the type of surgery, including international travel which I might plan to do. I’m certainly not banking on that being true but it would be great if so!