Not Her Mother's Hysterectomy

"But I don't do that kind of procedure," she replied.

[an error occurred while processing this directive]

"Yes, but isn't there anyone who does?"

"Yes, but most of them aren't really good at it yet."

"Okay, but is there one person in the entire Washington area who might actually be good at it?" I asked. That's when she told me about John George.

Exaggerated Risk

Most gynecologists who don't do minimally invasive surgeries tell patients that " 'in my hands, the best procedure is an abdominal hysterectomy.' And that's true," explained Franklin Loffler, associate clinical professor of OB-GYN at the University of Arizona. "If they're not comfortable doing another procedure, it's not the best."

When it's time for a hysterectomy, say some experts, too many women don't go shopping. "If your family doctor told you that you have colon cancer, you are going to look for the best colorectal surgeon," said Lauren Streicher, assistant professor of OB-GYN at Northwestern University Hospital and author of "The Essential Guide to Hysterectomy."

But women usually feel comfortable with the gynecologist they've seen for years and guilty about looking around for another surgeon. "It's an established relationship, almost like a family doctor," Streicher said.

Old myths -- including the one about minimally invasive surgery being excessively risky -- die hard. Research shows that, in experienced hands, the risk of minimally invasive procedures is the same as or less than the risk of abdominal hysterectomy, Streicher said. The key, the experts I spoke with agreed, is to get several opinions and to ask a lot of questions. Then, if you decide less-invasive surgery is right for you, find a surgeon who has done hundreds of procedures.

Some hysterectomies, particularly where uterine cancer or severe endometrial scarring is involved, may always require abdominal incisions. But George says that 80 percent of the hysterectomies now done abdominally could be done laparoscopically.

"Ninety percent of the second opinions I see have been told that they are not candidates for laparoscopy, and I say they are," Streicher said. "The only one who can tell you if you are a candidate [for a particular procedure] is a doctor who does it."

A final note: Beware unrealistic expectations on the cosmetic front. I got rid of a melon and expected to drop 10 pounds and a pants size. Oh, well. Even my gigantic uterus weighed only a little over two pounds. (A normal uterus weighs just four or five ounces.) My pants fit a little better, not that most folks would notice.

Then again, before the surgery, most folks didn't ask me if I was pregnant.

"You didn't look pregnant," my sister assured me. "You just looked 49 years old."

My husband was too smart to comment.

Stefanie Weiss has written many stories on midlife health issues for Health. Comments:health@washpost.com.

More Info About Hysterectomy

* "The Essential Guide to Hysterectomy," by Lauren F. Streicher (M. Evans and Co., 2004)

* Hysterectomy Resource Center, http://www.obgyn.net

* National Women's Health Information Center, http://www.womenshealth.gov

* National Women's Health Research Center, http://www.healthywomen.org

* National Uterine Fibroids Foundation, http://www.nuff.org

To find a surgeon, try:

* American Association of Gynecologic Laparoscopists, http://www.aagl.org

* American College of Obstetricians and Gynecologists, http://www.acog.org

* Society of Gynecologic Surgeons, http://www.sgsonline.org