Procedure: Laparoscopic hysterectomy
Consultant: Mr Ken Metcalf
“Mr Metcalf had been absolutely right to insist on the hysterectomy”
I had read somewhere that if you have bleeding from the vagina after the menopause, however slight, it is essential to go and see your doctor. I saw only a few drops of blood, but they were a bright red colour, quite different from the normal brownish discharge associated with menstrual blood. I sensed there was something wrong and rushed to my surgery. My own doctor was away so I saw a young woman GP. She did her best to allay my fears, saying she thought I might have a polyp in my womb, but nothing serious. She advised me to allow her to make an appointment with a gynaecologist.
I went to see Mr Metcalf. He examined me internally and said he thought there were some polyps, and felt they should be cauterised. Again, he reassured me that it was probably nothing serious, but said polyps might cause me problems at a later stage. I agreed to have it done.
This is an out-patient procedure, but it does involve a general anaesthetic. I did not have any problems from the anaesthetic, and no pain from the procedure. Mr Metcalf came to see me after the surgery and said everything had gone well, and that he had also done a D & C, that is removing some of the lining of the womb for analysis.
To my surprise I had a letter from Mr Metcalf a couple of weeks later, saying there was nothing to worry about but he would like to talk to me. He offered me an appointment which I kept. He had sent me a very calming letter, but of course I understood that something had to be wrong for him to wish to see me again.
At this meeting Mr Metcalf explained that the biopsy had found a precancerous condition, endometrial hyperplasia, and that it was at stage 2. He emphasised that this was not cancer, but that it could lead to cancer and that he strongly recommended a total hysterectomy.
The thought of having a hysterectomy is terrifying for most women. It is, of course, particularly upsetting for young women, and especially those who have not yet had children, or completed their family.
In my case those reasons didn’t apply: I am eighty years old, and my family was completed long ago. But my knowledge of this operation was based on my daughter. She had a vaginal hysterectomy about twenty years ago. It affected her quite badly and, though she is normally very active and energetic, she took several months to recover fully. So I felt that at my age such major abdominal surgery might be a big problem. Furthermore, I’d always understood that cancer, even if it developed, would grow slowly at my age. Why not just risk it?
Mr Metcalf was very insistent that his recommendation was to have the operation. I know him to be an outstanding gynaecologist and surgeon, so of course I respected his advice. However, I do like to do my own research. I went onto the Internet, and I talked to some research people I know in the United States who are experienced in this field. The response was unanimous: it would be most unwise not to have this operation.
The question now was how was it to be performed? There are three options: an incision in the abdomen to take out the uterus, the ovaries and the cervix, an operation to do this via the vagina, or a laparoscopic operation where the surgeon cuts the connecting tissues using small holes made in the abdomen, and the uterus, ovaries and cervix are then removed via the vagina.
Mr Metcalf explained that the vaginal option was not suitable in my case. It seems the vagina narrows with age, and that makes it difficult for the surgeon to perform the operation. That left the incision and the laparoscopic options.
After thinking about it I decided that the laparoscopic method was the one I preferred. I felt that I might never regain proper abdominal muscle tone after a large incision in my abdominal wall at my advanced age. Mr Metcalf agreed that I could have the laparoscopic hysterectomy, and said he would work with Mr Moors, an experienced surgeon on his team specialising in laparoscopies.
The operation was performed by making three very small incisions in the abdomen, and also using the navel as a fourth channel to insert surgical instruments. It was simply amazing; the first thing I remember on coming round from the anaesthetic is being asked what pain I was experiencing, on a scale from 1 to 10. Actually, I had no pain at all.
No doubt I was particularly lucky, but I had no pain at any point after the operation. I felt well, and was able to get up and walk as soon as the nurses disconnected me from various drips. The operation was performed one late afternoon, and I was able to go home the next afternoon. There were no following problems.
So far, now six weeks after the operation, I have not had any problems at all. My only difficulty was not to undertake too much physically. Though there was no large external wound my insides had to be able to heal. I was encouraged to exercise by going for walks, but not to lift anything heavier than a kettle filled with water for one cup, and not to do housework. These prohibitions are not too great a price to pay for a good recovery.
The biopsy on the uterus following the operation did, however, discover a small cancerous tumour. Mr Metcalf had been absolutely right to insist on the hysterectomy. If I had known how easy it would be I would not really have hesitated. Catching a tumour at this relatively early stage is the best way to combat cancer.
I would like to reassure other women that the laparoscopic approach to hysterectomy can really make even such a radical operation as a total hysterectomy easy to cope with. Of course it is still a major operation; of course it will prevent you from having children if you are of child-bearing age. But you have a good chance to be protected from whatever disease you were diagnosed with, and the recovery period is relatively short.
Mr Moors told me at our initial meeting that I wouldn’t know I’d had the operation within four weeks. He was absolutely right.