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Debating type of hys. Debating type of hys.

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Unread 05-03-2006, 05:51 PM
Debating type of hys.

I am supposed to go see another gyn. 5/12 to discuss LSH (he said that he has been doing this procedure for about a year and a half and has done 25 with excekllent results...wondering if he is a 'babe in the woods' and wanting more practice). I am starting to wonder after reading a lot of different info if I should just have an open (abdominal) hys. I read on several different medical sites that the risks of serious complications are about twice as high with laparascopic than abd. hys. Any opinions on this?
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Unread 05-03-2006, 06:22 PM
Debating type of hys.

Hi Lori,

I had a LSH.

I think you point out some important questions. In my opinion, It is important to have a trained surgeon with a LSH. 25 surgeries is not a lot and it is not his first one.

Also, from what I understand, a LSH Dr. has a back-up Dr. that assists wih the surgery. In my case, with my surgery, it was a 2nd LSH Dr. You might ask your Dr. who his back-up Dr. is.

Also, you might ask your Dr. where he got his LSH training. My LSH Dr. had some training with a Harvard based Dr. so that helped with my decision. I mean..if your Dr. went to some medical school you have never heard of, maybe something to think about.

Also, withe the risk factor, in my opinion, it can happen with ~any~ type of hyst. That is why we ladies sign release forms before a hyst.

Don't worry. You will make the right choice. It comes down to what is best for YOU - an abdominal or a LSH. You get the final vote.

Unread 05-03-2006, 06:47 PM
Debating type of hys.

I had an LSH as well. It was a great procedure for me. I, too, would question the amounts of surgery time your Dr. has had. Perhaps like History Lady mentioned, he will have another LSH Dr. during the procedure and this Dr. may have more surgeries under his/her belt. My Dr. worked with his PA. The two of them are great. You'll find the right procedure for you. Best wishes.
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Unread 05-03-2006, 11:43 PM
Debating type of hys.

boy this is hard because none of us can tell you what you should do, as it is very personal. I can tell you my story, which is that I decided I wanted to have the surgery that the doctor is the most used to doing. It is my OPINION (since that is all I have) that 25 is not very many. I had my surgery done in an urban teaching hospital where my doctor does 25 hysterectomies probably in a month. Meaning she has done hundreds. The other good thing about a teaching hospital is that all decisions are challenged. Before the surgery I was examined by a team of 3 doctors plus 2 medical students (that was fun) and they argued about whether I could have a vaginal hysterectomy (the size of my uterus was borderline). They decided it needed to be abdominal. I actually preferred the abdominal because the doctor can really see what she is doing, and I didn't care if I had a scar below the bikini line. You should research research research on the internet, don't be afraid to ask the doctor questions (this is YOUR life) and make the decision.
Unread 05-04-2006, 10:16 AM
Debating type of hys.

I was in the same boat, but before my hysterectomy, had to decide between LAVH and TAH. My question to you would be what is the reason for your hyst? In my case, because it was for endometriosis, my doctor and I discussed in detail the risks and benefits of both surgeries. It was a close call, but in the end I decided that because there was less time on the table with an abdominal, and less risk of knicking the bladder or other things with the scope and other instruments, and because in an abdominal procedure the doctor can manually feel, and visually inspect, the ovaries, we went with an abdominal. I will warn you that I firmly believe now (two weeks post op) that it does indeed cause at least one week to 10 days more recovery time. The abdominal incision has its own risks, but in my case I felt more comfortable with the TAH than the laparascopically assisted procedure. I know there are others on the board who LOVED their lap procedure and would never want an abdominal incision. Mine is horizontal, and lower than my bikini line, and very thin. My decision was best for me, but I know how it feels to be "on the fence." The good news is that either way, you'll get the procedure done and be done with the burden of whatever is leading you to have the hysterectomy. Best wishes and blessings to you!
Unread 05-04-2006, 10:24 AM
Debating type of hys.

Thanks. I am under the impression that I have possible endometriosis and adenomyosis. May haave adhesions or scar tissue. Heavy periods with clots for about 9 days a month, pelvic pain. I just got an e-mail from the doc I saw once who was supposed to do the surgery, but she seems to be antsy about me asking her questions about her experience. According to her, she has done between 200-300 LH's in the past eight years. The other doc I am going to see tomorrow has been practicing medicine a lot longer, but has only been doing the LSH for about a year and a half and has performed about 25. What seems like the better deal?
Unread 05-04-2006, 11:03 AM
Debating type of hys.

In my opinion (if the surgeons think an LSH is appropriate for your particular situation), you are better going with the surgeon who has done 200-300 LSHs, not 25 LSHs. Laproscopic surgery, like any other technique, takes a while to perfect, and someone who has done 250 of them has had far more practice than someone who has done 25 of them. Most doctors who specialize in laproscopic surgeries do tend to be younger (in practice for about 8 years is probably pretty standard for a laproscopic specialist), just because older surgeons were trained before the techniques were being taught.

I kind of feel for surgeons learning a new techique--how are they supposed to get skilled, if they don't have bodies to practice on? That said, I would always prefer someone who has had tons of practice before they work on me!
Unread 05-04-2006, 11:04 AM
Debating type of hys.

This is going to be your decision in the end. One thing to consider is the amount of time you'll spend under general anesthesia. I believe it takes longer to do the lap because they have to cut your uterus into several pieces. Also, if you have endo it's going to be harder for the doctor see in there.

The decision was easy for me because I went with what my doctor thought would be best for me. He's been doing it for 25 years and has the experience of countless women to base his desicion on. I didn't care about the scar from the TAH or the amount of recovery time. I wanted it done right. My decisions were wether to keep my ovaries and cervix. I kept my ovaries but wanted no part of my cervix.

Keep in mind that the things that get cut on the inside are all the same regardless of which method is used. And it will take the same amount of time for your insides to heal.
Unread 05-04-2006, 01:47 PM
Debating type of hys.

You mention having endo and adhesions... just my here, but, if it were me, I would not want anyone with a whirling cutting instrument fishing around inside me under those conditions. Everything being 'glued' together inside, there is just too much risk of hitting something that shouldn't be cut or not getting as much of the endo as possible.

And, yes, the complication rate is higher among lap hysts than open procedures. If you visit our Resources directory and do a search there on 'complications', you can find several good accounts of relative complication rates of different hyst procedures.

IMHO the best procedure in any individual case is the one recommended by the DR most experienced and familiar with the individual's medical history and particular circumstances.

Unread 05-04-2006, 02:24 PM
Debating type of hys.

My dr. preferred to do a TAH, due to my high cervix, large uterus, endo, fibroids, and a cyst on one ovary. He wanted a good look at what was going on. Since this is major surgery, I got a second opinion before making a decision. The second dr. I saw wanted to do a LAVH. He basically poo-poo'ed the reasons my regular ob-gyn had for going the TAH route. I was very uneasy with my "second opinion" dr. He made a diagnosis of my condition and was ready to do surgery in four days without ever seeing any of my records, charts, sonograms, etc.

I ended up staying with my regular dr and the TAH. I've had no problems/pain with my incision and feel like I'm having a very good recovery. By the way, the doctor also had a second dr. assisting him in the OR. Just standard procedure for their practice...

Good luck with your decision!

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