laparotomy vs laparoscopy

[AnneUK37]

My gynaecologist suggests a laparotomy and oophorectomy to remove a 4.6cm lesion containing solid and cystic components. She will also perform hysteroscopy and cystoscopy to check for source of blood in urine.  I also have a retroverted uterus. When my gynaecologist explained why to do the laparotomy rather than laparoscopy she said she did not want solid material to spill(?) When I phoned a gynaecologist in my home country he said this procedure could easily be done by laparoscopy using a bag against leakage, especially given my age (37).My question is should I refuse treatment by the first gynaecologist given that I don't want a huge scar if it can be avoided or are there other good reasons to trust this specialist' judgement. Should I insist on the free fluid in my pelvis to be analysed? The tumor markers are normal. Thank you very much for your advice. I wish I did not have to worry about this.

[Annekathryn Goodman, M.D.]

Hi There
yes , performing a pelvic wash for cytology is a standard part of the surgery. I suspect your doctor knows that as she has thoughtfully told you she is worrying about rupturing the cyst. But she will, I am sure, be happy to discuss this with you as well.
best wishes

[Annekathryn Goodman, M.D.]

Hello,
thank you for your question
I think about the issues of surgery as having two very different parts.
the first part has to do with the goals of surgery: diagnosis, removing a mass, preserving fertility, and so on
the second part has to do with technique and tools.

surgeons will chose from part 2 the tools they need to accomplish part 1.
So if your surgeon has examined you and looked at your scan and feels that the best tools to accomplish the goal include a laparotomy, you need to know that she feels this is the best and safest way to do it.

it is easy to discuss things theoretically and say that laparoscopy might be better. But that is just a tool. It has a higher surgical complication rate and if someone has a cancer, it may be an incomplete way to treat it.

However, you could get a second opinion which includes an exam and a  look at the films Another surgeon may decide that laparsocopy is safe for you or agree with the first doctor.

best wishes and good luck

[AnneUK37]

Thank you very much for your answer...the fact that you don't immediately say 'yes I don't understand why a laparoscopy will not be done' gives me more trust in that the gynaecologist has decided the right thing. I meant to take away the worry part in my 1st post as a scar is only a small worry compared to what other forum users are worrying about. I read from other posts that it won't prevent me from having a c-section later on. Would you still insist the pelvic fluid gets examined as well given that tumor markers will only go up when in advanced stages of c...
Thank you again for your kind help.

[AnneUK37]

No more questions...Thank you very much for making time to answer these...