Excerpts from The Essential
Guide to Hysterectomy

Chapter 8:
Laparoscopic Hysterectomy

If you are not scheduled for a laparoscopic hysterectomy, you need to know if you should be.

Twenty years ago, every person who needed his or her gallbladder removed ended up with a large incision and weeks of painful recuperation. Laparoscopic cholecystectomy first became available in the late 1980’s and within ten years virtually all cholecystectomies were being done with the less invasive technique unless there was a specific reason not to. Most general surgeons learned the procedure, and routinely offered it to their patients. If they did not, they were out of business, as patients became aware that a laparoscopic procedure was available.

Contrast that to hysterectomy. Although first developed in the early 1900’s (by a gynecologist), it wasn’t until the 1980’s that laparoscopy was used routinely to make diagnoses, treat ectopic pregnancies and perform tubal ligations. The first laparoscopic hysterectomy was accomplished in 1989.   

In spite of the fact that laparoscopic hysterectomy has been technically feasible for over fifteen years, and in spite of fact that it offers many advantages over abdominal hysterectomy, it is rarely offered. More than a decade after the first laparoscopic hysterectomy, less than 10% of hysterectomies are performed totally laparoscopically. Approximately 70% of hysterectomies are still performed using an abdominal incision. The small group of surgeons who are expert laparoscopic surgeons would argue that many of those could have, and should have, been done laparoscopically.

Chapter  13
The Cervix Decision

You’ve decided to go ahead with the hysterectomy. You’ve weighed the options, considered the alternatives, talked to surgeons, set the date. You feel you’ve done your homework until a friend casually asks you, “Are you going to remove your cervix when you have your hysterectomy?” Panic sets in...Another thing to think about, yet another decision.

Prior to 1940, almost all hysterectomies were sub-total; that is, the cervix was rarely removed along with the uterus. In the 1940’s and 50’s, total hysterectomy (which includes the uterus and cervix) became the standard of care as a means of preventing cervical cancer. Today, the vast majority of hysterectomies still include removal of the cervix.

A study which was published in Obstetrics and Gynecology in August of 2003 reported that only 18% of gynecologists even broached the topic of sub-total hysterectomy as an option in spite of the fact that virtually all felt that the risk of subsequent cervical cancer was negligible. Since screening techniques have reduced the incidence of invasive cervical cancer to less than 0.1 % for low risk women, it is appropriate for gynecologists, (and patients), to question the routine removal of the cervix at the time of hysterectomy. 

Chapter 15
The Day of Surgery

It’s 5:00 A.M.; you’re feeling anxious, hungry, slightly nauseated, gripping a suitcase and wishing you were on the way to the airport instead of checking into the hospital to have a hysterectomy. Focus. Remember the bleeding, the pain, and the constant pressure on your bladder. Remember you made this decision because it’s the right thing to do and you’re going to feel a whole lot better.

Check-In
Once you arrive at the hospital, check in may seem excruciatingly slow considering you’ve pre-registered and insurance has already been cleared. Once you have checked in, depending on the hospital, either you are brought to the room where you will be staying after surgery, or more likely, to the holding area.

Holding
The holding area is where you wait just prior to going into the operating room. Operating room time is obscenely expensive, so everything that can be done will be done, prior to actually entering the operating room.

The opening in the attractive gown you are given is not there to allow everyone can see your butt;  it’s there so the gown can easily be taken off once you are asleep.  You may be given socks or slippers.  Don’t plan on wearing your own unless you never want to see them again. The matching hat comes later. 

The holding area for surgery is very similar to the terminal where airplanes wait to take off.  It is where all last minute safety checks are done in preparation and yes, people in carts are often queued up like planes on a runway.   Sometimes there are little cubicles; more often you are separated from your neighbors by a curtain.  You usually are allowed to have a visitor stay with you. Make sure it’s someone who makes you feel less anxious.  Perhaps your mother-in-law is not the best choice.

Now that you’re in your attractive outfit, with no make-up, no contact lenses, no sleep, and feeling more than a little anxious, you get to meet lots of new people. The last thing in the world you’re in the mood for is to make a nice impression…but not to worry, no one is making a judgement about how you look and act. Everyone knows you usually look much more attractive. Everyone knows you are wishing you were someplace else. No one expects you to be particularly charming. 

Chapter 25
Associated Procedures: Time For That Tummy Tuck?

It’s no coincidence that your friend who had a hysterectomy a few months ago actually looks, well, different. Younger actually, more rested. She of course is saying that the few weeks off work did her a world of good…not to mention that she’s not anemic from those nasty fibroids anymore. The truth is, she may have taken advantage of the “down” time from her surgery to have a few other things taken care of.  Like her face, breasts and protruding belly. For many women, a medically indicated operation is the ideal time to sneak in some bonus surgery.
Very few women are thrilled about having to have a hysterectomy. Even though intellectually you know it’s the right thing to do, and will benefit you in the long run, it’s a complex decision, that is often psychologically difficult. Having a hysterectomy, more than any other type of surgery, stirs up all kinds of troublesome emotions…getting older, end of potential fertility, and for some, the beginning of menopause.  Planning a cosmetic procedure that you’ve always secretly wanted is a way to turn things around. You may be losing your uterus, but at at least you’re gaining a flat stomach and perky breasts.