Bi lateral salpingo oophrectomy

Hi Monalisa,

I had a full hysterectomy two years ago with the bi lateral, due to suspected endometrial cancer and I am post-menopausal so the surgeon just wanted to get everything out just in case of future problems. I had a very early stage cancer and it hadn't gone anywhere else.

So I had the whole lot, via keyhole. Tbh despite it being my first ever surgery and first ever visit to hospital, and despite being absolutely terrified in the lead-up, I had no issues during surgery and very little problem with healing afterwards.

I think they warn you that it might be open surgery just for that 1% chance that they might have to convert it at the last minute if any problems show up during surgery. They seem to only do the open as a very last resort, once they have ascertained that they can aim for successful keyhole. Your signing consent is just to cover them so that they don't have to abort the surgery in the very unlikely chance that a last-minute problem shows itself once you have been put under.

The keyhole is minimally invasive. Internally, you will have a lot of healing to do, which is why you need to stick to their recommendations which will be something like, no lifting or strenuous activity for six weeks and caution for a further six weeks. Externally: I had two small incisions plus a third through my belly button. The two small ones healed really quickly, and the belly button was a bit itchy for a couple of weeks or so but I would massage it which helped to relieve the discomfort. It wasn't painful - just slightly sore, and the slightly itchy belly button. I had a vaginal cuff which I didn't even feel any discomfort from. However, my surgeon advised me to not sit on a hard chair at all for at least two weeks and to not sit for more than twenty minutes at a time for up to 4 weeks. 

What they do is insert the surgical instruments in via the three incisions, then remove everything via the vagina, hence the vaginal cuff. 

Regarding anxiety: I lost a lot of sleep and had several panic attacks before the surgery, never having had a GA in my life and not knowing if I might be one of the minuscule percentage who are allergic to anaesthetic! I tried Rescue Remedy, which had no effect on me, and my only coping strategy really was to tell hardly anybody, to shut it out of my mind, and in fact I realised afterwards that I had coped only by separating the healthy person I had been for 62 years, from the person going into hospital. It was a surreal feeling, as if I were two separate people. But it kind of got me to the point of being able to walk into that hospital on the day of surgery.

You could find that something like immersing yourself in gentle music, will help relax you. I did start a crime fiction book once I had the date for surgery, and that was intricate enough that it drew my mind away somewhat from the forthcoming appointment. 

I went into surgery just before 10am, I was back on the ward before 11.30 and sitting on the edge of the bed eating a two-course lunch at midday! I spent the rest of the day and a half in hospital, taking walks up and down the corridor every hour or so. There was suggestion that I would wake up with a catheter in and I asked the surgeon if he could take it out before I woke up, if possible - which he did. That also enabled me to feel a bit more human a bit quicker, and of course to be able to take my regular walks along the corridor. 

I did dread that surgery so much...but once I had come out the other side, I had an intense feeling of relief - no more worries that what was inside me, would grow and spread. 

Not sure if any of that will help in any way...I am just recounting my own experience and emotions; everyone is different from anyone else, but the modern methods of keyhole surgery really do help shorten both surgery times and recovery times, so hopefully there will be no reason why yours won't go ahead as keyhole and what impressed me the most - this from someone who had never ever had a GA - was that as soon as I started to feel "woozy", I was right back on the ward and wide awake!! It felt like about ten seconds between!! Quite a pleasant sensation in a way! 

Hi Monalisa 1869, 

I had a total abdominal hysterectomy and bilateral salpingo oophorectomy just over a year ago due to a thickened uterine wall, large cervical fibroid and ‘swelling’ on my right ovary. They also did peritoneal washes to check for stray cells, since they suspected cancer, but everything ended up being benign. 

I was told by the consultant I saw initially (not her senior colleague who did the actual operation) that the MDT thought the op could be done by keyhole but that the position of the fibroid was ‘challenging’ and there was a ‘small chance’ it would have to be an open surgery. I then saw a private consultant who unnerved me by saying she’d be going straight for open surgery since the surgeon wa a brave man if he thought he could tackle it by keyhole! In the end, the senior NHS surgeon who did the operation also disagreed with the MDT and open surgery it was. A longer stay in hospital and a longer recovery period but it just meant I was pandered to and spoilt for longer .  

The reason you’ll have been asked to give your consent for both keyhole and open surgery is that often they’re unable to assess exactly how best to go about things until they’re actually dealing with it. Surgeons don’t take chances; your safety is paramount and they’ll make the decision on the day (keyhole or open) that’s right for your situation. 

As far as preparing yourself for the surgery goes, look after yourself, eat well, keep active and try not to worry (easier said than done, I know!). 

All the very best for your op. Keep in touch and let us know how you’re doing. 

Oh wow thanks so much for your reply it’s really helpful. That’s what I did when I had my breast cancer in 2021 with a lumpectomy chemo and radiotherapy i seemed to look at it from the outside of melf if that makes sense? I’ve got my preop tomorrow with a list of questions - one hour I seem calm and the next I’m a panicked mad woman. Fingers crossed mine is as straight forward as yours - I mht ask about removing any catheter before I wake aswell - I can get bad thrush and cystitis so don’t want to take a chance. Hope you are keeping well and thanks again - you’ve been really reassurinand positive lx

Thanks so much for your reply - it’s the size of the cysts that worries me as last time I was scanned in Jan 2024 (yes 18 months ago!!!! Apparently they won’t scan again!) they were 12cm and 10cm and I’m worried they may have grown or I’ve got more and surely keyhole surgery is tiny cuts so how would they be removed? But the other kind lady said they’re sometimes removed via the vagina - it’s already on my list of questions for tomorrow. I’ll let you know how I get on and def trying to be calmer and more positive now I’ve got these first hand experiences as I’m a terrible one for checking “doctor google” even though I know I shouldn’t lx

Glad to see you have a list of questions! - you need to feel as informed as you can be, because that's what puts you in control of something that technically we cannot control. I tend to go OTT with the questions! - my consultants grimace when they see me come in with my long list!! - but better to be well-prepared than not. I never have anyone to go with me, so have to rely on my list and writing down the answers to my questions. 

Do ask about the catheter being removed. I was so glad I did. The very elderly lady in the bed opposite me still had hers in until just before she was discharged and kept saying, "oh isn't it lovely to not have to get out of bed to go to the toilet!" and inside I was screaming, NOOOO it would be absolutely horrible to have no reason to get out of bed!! 

I have been on the other end of catheters a lot, in various roles as a carer, but had never had one. However, I had to give in and have the experience in April this year when I had my kidney surgery - and omg never ever again!!!! I wouldn't walk around carrying my bag of wee, so was literally tied to one side of my bed - as far as the tube would stretch. I kept telling the nurse I was desperate to wee, and she said, but you are weeing, and I said, No I'm not!!! She finally deduced that what I was feeling was the balloon irritating my bladder. It kept wobbling around inside also. I tried to get comfortable/sleep unsuccessfully, and had begged the senior nurse to remove it but she avoided me and went off shift! I asked them so many times, were they absolutely promising that it would be removed at 6am? I couldn't settle and was still pacing up and down one side of my bed by the time one of the night duty nurses took pity and removed it for me at 12.22am!!! at which point, I went to the toilet and then got into bed and had some proper rest and sleep for a few hours. 

I asked a nurse if everyone with a catheter had the same feeling as I did, and she said, possibly. I told her that in retrospect I felt soooo sorry for all my poor care clients who had had to live with one for sometimes weeks and months, even years! 

I think I am a very impatient patient! I'm so active, and not used to being on the receiving end of anything that prevents me from living my normal active life. 

Good luck for your pre-op. Hopefully you will sail through the surgery...the keyhole isn't really troublesome, as the incisions they make are few, and in theory it's not a long surgery so you shouldn't be under for any length of time, if all goes to plan. 

As far as I know, they are always removed through the vagina if you have the keyhole. There's a chance they may enlarge one of the incisions on your abdomen, to remove them, if you are literally only having the cysts removed and nothing else - I had the full monty of womb and everything, but it still all came out through the vagina. If they enlarge one of the abdominal incisions, because our bodies are flexible and not rigid, the incision may still be smaller than you would imagine it would need to be. The consent for open you were asked to sign, may be in case when they get in there, they find one or both cysts have grown since you were last scanned. Definitely a question to clarify with your consultant tomorrow. 

Oh wow I will definitely ask about a catheter - I’m on my own and have been through my breast cancer surgery and treatment during covid which was rough. My parents are in their late 80s and I don’t like them to see how scared I am. I don’t have brothers or sisters or husband-partner but I’m lucky I do have 2 close friends who do so much for me. One of them is taking me to the hospital in the day and will look after my cat if I’m kept in. Because I’m diabetic they’ve said I prob will stay in which scares me as when I spent 2 weeks in the same hospital as a result of an A&E admission I spent time on 3 different wards and each bay I was in had patients who were physically well bur mentally unwell and I was terrified of one of the ladies who attacked staff and had a 1-1 nurse with her 24/7- I just want to come home to my cat and my own bed. Because I had TNBC there’s a higher risk of ovarian cancer and although i don’t have the BRACA genetics I’m worried what the cyst results will show - can’t believe they won’t do another scan before the op! But maybe I don’t want to know if there’s more or they’re bigger. I have a list if questions tomorrow just hoping the nurse is nice cause I may cry lx

Thanks again I’m having fallopian tubes ovaries and the cysts removed. I had TNBC which means higher risk of ovarian cancer although BRACA genetics came back negative still a worry when they examinthe cysts - just hoping they are okay. They said they can’t tell anything from the scans other than that they are “complex cysts” whatever that means! I know consultant was right when she said if is all removed then I can’t get any more cysts but sometimes my mind goes wild. I’ve not had much luck the last 4 years as had BC, then developed ulcerative colitis which isn’t great at the moment ptly cause of the stress of all this and then diagnosed with diabetes so feeling like I deserve a bit of luck - not sure why my words are appearing funny sorry. Hope I have a patient nurse tomorrow, will let you know how it goes. Thanks again for the advice lx

You've had a terrible 4 years by the sound of that! I do hope maybe your luck is going to change after this next hurdle. 

I think a complex cyst, just means it looks like the cells are growing abnormally. Which is what cancer is, effectively. That said, going on the description of kidney cysts (which is where I've been these past couple of months), it's possible to have a complex kidney cyst that isn't malignant. Bosniak III kidney cysts are classed as complex, but only about 50% of them are actually cancerous. So whilst your ovarian cysts look like complex ones, they can't tell for sure until they do the histology. 

Hi  

Looks like Maite has given you lots of great info re what to expect with keyhole surgery and totally agree it’s good that you have questions ready .

I also have a vaginal cuff but that’s because my cervix was removed. Basically, the vaginal cuff replaces the cervix so I don’t think you’ll have one if they’re only removing your ovaries. 

Because I had an open surgery, my catheter had to stay in for 24 hours (first experience of a catheter for me too). It was removed once I was on my feet - a quick and painless procedure, although it had obviously caused a bit of irritation as my pee was a bit bloody for a while. 

I never did find out what the ‘swelling’ on my right ovary was and I forgot to ask (MRI suggested cyst or broad ligament fibroid). Think I was just so relieved that it was benign (mum and granny both died of ovarian cancer that was discovered far too late) so I figured they could call it what they liked, the main thing was it was outta there  However, my MRI also picked up a 7cm cyst on my kidney which Urology confirmed was a simple cyst. I was told that whereas simple cysts are benign, fluid filled sacs, complex cysts (though generally also fluid filled) may contain some more solid matter and have a very small chance of being or becoming cancerous if left to their own devices, so it’s good that your getting rid of them

We’re with you 100%. Keep us posted