A Second Look at Hysterectomy
About a year ago, Diane used to complain that she was always suffering from unbearable cramps and heavy periods. When she finally had herself checked she found out there was something wrong with her uterus and bladder, which explains the abdominal discomfort she was always feeling. The prognosis was promising but her doctor told her she needed a hysterectomy.
Aside from a heavy period and menstrual discomfort, indications that necessitate hysterectomy are uterine fibroids, severe vaginal bleeding, uterine prolapse, endometriosis, chronic pelvic pain and uterine or cervical cancer.
Scared of surgeries, Diane sought a second opinion. Unfortunately the second opinion she got did not give a different recommendation, but the second doctor did offer a better and less invasive procedure than the typical hysterectomy. It was laparoscopic hysterectomy.
Unlike the traditional hysterectomy, the laparoscopic one does not entail a big abdominal incision and would involve only minimal downtime. True enough Diane was in and out of the hospital after the procedure, which was what she preferred to being bedridden and feeling helpless while recovering from surgery.
The New Trend – Laparoscopic Hysterectomy
Laparoscopic hysterectomy is the new trend in hysterectomies. Actually, laparoscopy is also being used in appendectomy, gallbladder surgeries and is considered an emerging trend in urology and cardiology, among other fields.
The biggest contributor to its acceptance is the short hospital stay and faster recovery time of patients. Compared to those who had abdominal hysterectomies, patients who underwent laparoscopic surgery can resume their normal activity within a few days.
Moreover, as a patient would you prefer a big abdominal incision to a “keyhole” incision, usually in the belly-button? Would you like a slow and oftentimes painful recovery instead of a quick few days at the hospital?
Advantages and Disadvantages
Almost any woman would opt for a laparoscopic hysterectomy, given what we have discussed earlier. But the cost of the procedure might be a deal-breaker. Sadly, because of the many advantages in terms of degree of invasiveness and recovery time, laparoscopic hysterectomy costs double than what a typical abdominal hysterectomy would cost.
Moreover, since laparoscopic hysterectomy is still fairly new, a patient opting for one might have some difficulty finding a highly skilled surgeon. Otherwise, you might be in for more harm than good if you would settle for a neophyte laparoscopic surgeon. Surely, you wouldn’t want a novice to use you as a guinea pig to help perfect his craft.
What Questions to Ask Your Doctor
Aside from how much he will charge you, the more important question to ask your doctor is how many laparoscopic hysterectomies he has performed over a given period of time. The preferred answer would be at least 30 to 50, any number lower than this should tell you to look for another surgeon.
Another important thing to ask about is his “conversion rate”. A surgeon’s conversion rate is the percentage of the number of times he started with a laparoscopic incision but decided that an abdominal one is more feasible. Strive to find a surgeon with a conversion rate of less than 5%. This indicates that the surgeon is comfortable performing laparoscopic surgeries and seeing it through rather than reverting to abdominal surgery midway into the operation.
Your physician should also be able to provide you with options. He should be well-versed with the advantages and disadvantages of both procedures.
The Emotional Side to a Hysterectomy
There was a time when women of child-bearing age who have been diagnosed for hysterectomy had to make tough decisions. Since hysterectomy removes a part of, or worse, the whole uterus it results in the loss of the ability to ever have children.
Depending on the personal choices they have already made, some women may be just plain thankful to be finally relieved of heavy bleeding and menstrual cramps. But for those who long to have a family of their own, the loss of the ability to bear a child can be very devastating.
Gone are those days. Hysterectomy is no longer the only option for women nowadays.
- For heavy bleeding, medications and the IUD, Marena, solves the problem for most women.
- Uterine fibroids can now be removed by a surgery called myomectomy, which leaves the uterus intact.
- Uterine artery embolization and endometrial ablation reduces heavy bleeding by destroying the lining of the uterus. However, most women have difficulty getting pregnant after endometrial ablation, while it is not yet proven if uterine artery embolization reduces the chances of getting pregnant.
The bottom line is hysterectomy does not have to be the automatic treatment of choice.
To have Ovaries or Not?
Back in the olden days, another tough decision a candidate for hysterectomy is forced to make is whether she wants to hold on to her ovaries or not. Aside from getting a hysterectomy, a woman can opt to have her ovaries removed through a procedure called oophorectomy. But oophorectomy, once resorted to, leads to premature menopause, the biggest consequence of hysterectomy. Soon after hysterectomy and oophorectomy, a woman-patient will experience all the hormonal changes, mood swings and hot flashes associated with menopause which can only be contravened by taking on hormonal pills.
These days, women are given the opportunity to choose not to undergo oophorectomy alongside her hysterectomy. Surgeons no longer have “clean sweep” mentality of taking everything out while they are on the operating table.
The necessity to make the decision to have an oophorectomy is left to those women whose families have a history of ovarian or breast cancer. You see removing the ovaries causes hormonal changes that are recognized as a preventive measure to reduce ovarian or breast cancer risk.
However, removing the ovaries also result in the loss of sexual appetite, for which reason doctors are advising women, especially those with partners, not to opt for oophorectomy. These doctors are fully cognizant of the fact that sexual appetite is not all that it seems to be. It is more intricately tied to a woman’s self esteem, her relationship with her mate and her emotional state. So unless there is a pressing medical condition that would require the removal of the ovaries, they would strictly advice against it.