1. Home in 12-24 hour if you want.
2. On oral pain treatment sooner.
3. Off pain treatment in 1-7 days.
4. Less nausea and bowel problems.
5. Less bladder dysfunction.

• Some back to work in 1 week.

• Three small (5 to 10 mm) incisions:

• You can remove the ovaries if you want.

• You need a bowel prep - I need all the room to work that I can get - One day of full liquids then one day of clear liquids before the surgery and a drug that flushes you. There are less gas pains and nausea post op - a benefit to you above and beyond the small incisions.

• Less lifting restrictions.

• Back to your sex life sooner.

• Restrictions:

1. Don't get sweaty for two weeks.
2. Don't have intercourse for two weeks.
3. Don't drive on pain pills.

• You have to go to sleep - no spinal or epidural.

• As with all surgeries in this area, there is a risk of death, bleeding, serious infection, transfusion, re-operation, conversion to larger incision, re-operation for damage to bladder, uterus and bowel. I have had none of these complications. I have had less blood loss with the laparoscopic approach than the other two approaches for hysterectomy.
After 200 surgeries over 2 1/2 years I have no transfusions, no complications, 5% have slight monthly cyclic spotting. I have re-operated 1 of the 200 for this bleeding.

IF YOU LEAK URINE

SPARC = Nylon sling bladder repair - Minimal pain - Outpatient

1 inch incision front wall of vagina 2 tiny incisions in pubic hair

It's a good idea to learn to cath yourself in the office before the surgery - It adds to your confidence that you'll be okay when you go home from the hospital. (Very rare that this is needed.)

REASONS TO REMOVE THE CERVIX

• It is hanging out (called prolapse).
• Too much discharge - the end is raw. Sometimes extra discharge is from the slow leak of blood from the uterus and therefore the cervix isn't the cause.
• Pain with intercourse - most of this pain is not from the cervix, I can help decide cause of pain during exam.
• Pre-cancerous change, always by exposure to the human warty virus, a sexually transmitted disease, so if you have no history of this you don't need your cervix removed. As long as you have a cervix you need a pap every one to two years.
• Tiny chance (less than 1%) that anything that could happen to the uterus like fibroids, adenomyosis or cancer could happen, but you can't go around cutting off everything that could have something go wrong with it. The message from this is "probably leave the cervix".
• Less than 5% chance of monthly spotting if you leave the cervix.
• You have to remove the cervix if you are doing a vaginal hysterectomy.

REASONS TO LEAVE THE CERVIX

• Most of the support ligaments to the top of the vagina hook to this. There is a greater chance for hernias if you remove the cervix.
• Less painful surgery. Laparoscopic hysterectomy hurts less than vaginal hysterectomy (vaginal hysterectomy takes the cervix). Abdominal surgery has bigger wounds and could take or leave the cervix.
• Less bleeding and discharge for four to eight weeks like you get post operatively if you take the cervix.
• You are back to intercourse sooner in two to four weeks vs. four to eight weeks. When you remove the cervix ten to twenty percent of the time you get a raw area that is discovered one to six months post operatively that can cause painful intercourse and discharge. This raw area can be destroyed with visits that involve treating the tissue with a burning type chemical. These visits are associated with minor pain.
• A few women have a pleasurable area on the front side of the vagina ("G" spot). The less cutting in this area the better (near the cervix).
• Some will have better lubrication if the cervix remains.

REASONS TO TAKE OVARIES

• 7% chance you get re-operated in years ahead.
• Decrease the 1/200 risk of ovarian cancer (not very high).
• Family history of ovarian cancer.
• Reduce risk of pain recurrence if endometriosis is present.
• Decreases pain with ovulation, acne, breast tenderness, and PMS for some people.

Wonder if losing ovaries would be good? - take Depo-Lupron as and experiment. Side effects not too bad - hot flashes and sleep disturbances that last 1 month.

REASONS TO LEAVE OVARIES

• Don't have to take hormones.
• May preserve sex drive - 8% complain of decreased drive if the ovaries are gone.