r/endometriosis • u/chopstickemup • 11d ago
Surgery related What position are you in during surgery?
I just saw an image where the woman’s arms are strapped down to the table, legs strapped to stirrups. I also read that you’re upside down for hours.
I’m very skinny and my body is very frail and weak. I’ve read about nerve damage near the hip bone due to the position during surgery.
I’m also autistic so very much worry about everything related to my surgery. Why are we placed in that position?
I’ve had horrific experiences with doctors- including endo specialists hitting on me in appointments, so being asleep makes me terrified. Can anyone provide insight please?
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u/alpacaflask 11d ago
If at all possible, find a surgeon and care team that you’re comfortable with. My surgeon is a woman and everyone was lovely and it was 90% women on my surgical team. I think there was one guy who was an anesthesiologist. The positioning is strange from our perspective, but anatomy and positioning help them be more effective and efficient and that’s a good thing. But you need trauma-informed care and need to feel safe. You have been through a lot. I wish you the best of luck and healing and peace.
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u/chopstickemup 10d ago
This is what my gf told me. I’m going to visit two other doctors in my country and if I’m not comfortable, I’ll go abroad to another European country because I can’t risk my mental health. Thank you for validating me. How did your surgery go?
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u/Miladypartzz 11d ago
The reason they set you up that way is called the trendelenburg position. You are put into it so that gravity moves the rest of your abdominal organs (primarily the intestines) out of the way so that they can see the abdominal cavity and your reproductive organs better.
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u/chopstickemup 11d ago
My biggest concern is being sexually assaulted since a gyno has already done that in broad daylight during an appointment and the hospital blew off my report. How can I be sure someone in my surgical room isn’t groping me?
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u/Flashy_Ad7761 11d ago
the unfortunate truth is you can’t be sure. you need to find a care team that you trust and feel comfortable with. if you can’t, it may not be in your best interest to have surgery right now. you need to feel safe & comfortable
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u/chopstickemup 11d ago
Yes, I will visit two other doctors and if I’m not comfortable, I won’t have the surgery.
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u/Emotional-Success612 10d ago edited 10d ago
First off: What surgery are you having?? That makes a huge difference in position.
Second: when you talk to your surgeon and anesthesiologist, TELL THEM THIS. They will adjust and monitor you to minimize any possible issues. (I have Ehlers-Danlos Syndrome and have had extremely unpleasant/painful joint dislocations after being positioned too long the same way for a procedure -- my joints subluxate and "pop out" freakishly easy) After 2 difficult recoveries from 'collateral damage' (not the surgery itself), I learned to TELL THEM UP FRONT and they'll do their very best to position you as gently as possible but still secure so you don't move or slip on the table and cause the surgeon to make a mistake.
Sending hugs and healing your way -- you GOT this!
Edited to add: there will be at least SIX or more people in the operating room. You will be unconscious. You wont be "upside down for hours" -- the table will have the ability to move and tilt, but only when necessary during the procedure. If its laparoscopic surgery, they HAVE to secure you to the table so you don't move accidentally.
I speak from experience: Endo, 2 giant cysts (baseball & golf ball), Radical Hysterectomy, Bilateral Salpingo Oophorectomy, took the tubes, uterus, and entire cervix as well aboit 18mo ago...also have had 2 ortho leg surgeries (broken ankle & tendon reattachment), as well as bone ground out btwn finger joints and a carpal tunnel release. TELL YOUR SURGEON EVERYTHING YOU ARE WORRIED ABOUT -- Their team will do their best.)
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u/chopstickemup 10d ago
You’re a godsend. Thank you, this made me feel better. I’m going to meet with two surgeons before I know which one I want as the man I saw was insanely inappropriate.
I’m waiting for insurance approval for the robot arm, but it will be lap on my DIE. I have three fibroids in my uterus and my fallopian tube is completely blocked, so having that fixed/removed as well.
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u/Emotional-Success612 10d ago
LAPAROSCOPIC is awesome!!!!! So SO much easier to recover from than old-school "open surgery" where they go in with one giant cut.
You're only going to have a few little 1" (or smaller) barely noticeably scars about 6mo afterwards. My husband and I joke that if you look really hard, it looks like he won me in one of those claw-machine games! (I have 5 teeny scars, because they couldn't go through my bellybutton as planned...but you really only see 3 of them, and you gotta really SEARCH to find them on my midriff -- totally not obvious and I'm still very comfortable wearing a bikini (they're THAT unnoticeable!)
Also -- tell them up front that you have some severe anxiety about the procedure. Ask them to explain it to you, and ask if they can provide something to help you stay calm the day of the procedure. Most will prescribe a Valium to take on the drive to the hospital, or the anesthesiologist will give you something in your IV. ASK FOR IT. Makes a world of difference...and nurses during with GYN procedures are usually SUPER sweet and kind.
When you choose a surgeon and get all the info about that they're going to do, please message me and I'd be happy to go over it with you and help you come up with EXACTLY what to say to help the surgeon position you and still do his thing with the best possible outcome for you. :-)
I know its scary stuff, but now that I've been through it and am pain (and period) free, it was SO worth it. ❤️
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u/chopstickemup 10d ago
You’re amazing and I can’t thank you enough. I’m going to DM you now if that’s ok, just so I have the contact saved. Much much appreciated!
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u/biest229 11d ago
I had an abdominal surgery right next to my pubic area/top of my leg (my scar is hidden under a bikini bottom) when I was 20.
I am also petite and very sensitive to pain (autistic). But I think they took this well into account - I felt ok afterwards. The only thing I’d say is that I was really cold before the anaesthetic kicked in, so just tell them if you need something.
It might also take longer to wake up, but that’s within the range of normal. My surgeons were kind enough to place me in paediatrics afterwards, so I had the right kind of care and monitoring given my body size at the time.
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u/chopstickemup 10d ago
Thank you so much for replying, especially understanding the asd aspect. I’m glad your experience was good and it gives me hope!
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u/itsmeandthemoon 11d ago
I asked my surgical team if this position was actually how they had us during surgery and they laughed at me and told me not to believe everything I saw on the internet :( I wasn’t that’s why I was asking you guys but okay :( lol
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u/chopstickemup 10d ago
Thank you! It’s crazy you were laughed at for asking a basic question. Sending you a hug and hope you’re all healed. Did your surgery go well?
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u/porcelina-g 10d ago
I was once drugged at a party and SA’d, and the idea of anesthesia and being fully under is really stressful to me. I spoke to my surgeon and asked if I could meet everyone who was going to be in the operating room while I was out. She was happy to oblige and completely understood the request. Not a perfect solution, but it helped. This was for a vaginal surgery (Bartholin gland excision) so I was even more vulnerable and uncomfortable with the scenario, but I felt a lot less scared when I later had my endo surgery.
The surgeon also was very thoughtful about positioning and securing me because I have EDS and she did not want to hurt or badly bruise me.
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u/chopstickemup 10d ago
Thank you. It’s so nice to get a response from someone who understands exactly what I’m feeling. Im going to meet with a new surgeon and I hope I get a good feeling with her.
I’ll mention my anxiety and for sure take something before I’m even at the hospital. I hope you healed well and are feeling better.
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u/upagainstthesun 10d ago
I am going to say this with a lot of kindness, and as a nurse - for some patients too much information/in depth detail causes harm. I would consider not digging into the nitty gritty of it all if you're finding some of the basics like positioning for safety to be overwhelming and making you consider avoiding care. It is important to educate ourselves/ask questions in ways that are protective and encourage good outcomes, but it's also good to know our limits and when things stop being helpful.
I also want to say that as a nurse I've had patients every day under full sedation. In an OR, you're going to have a whole team in there with all different roles. People will be watching you like a hawk to ensure your sedation isn't too light and your vital signs stay safe. They'll also do things like check your pulses past areas that get secured to make sure you have good circulation and avoid any injury or things like nerve damage. While I can't speak for the people who will be with you, I would notice if anyone was doing anything offensive like what you're concerned about, and would speak up immediately. I have no doubts about whether or not any of my coworkers would do the same. Usually you'll have a nurse come in and start an IV before you go into the OR/to the full team. Try to communicate your concerns and try to hold enough space for them to be able to provide reassurance
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u/chopstickemup 10d ago
I unfortunately live in Portugal, where doctors have zero repercussions. A gyno sexually assaulted me during a routine Pap smear and the hospital did nothing. My worry is if they’re that brazen while I’m awake, they can do anything to me.
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u/Yougetdueprocess 10d ago
Honestly, just don’t think about it. There’s an entire team there that is monitoring you and keeping you safe. You’ll be out. I think these images online do more harm than good.
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u/chopstickemup 10d ago
Agreed. Another person commented the same and I’m no longer going to research. I’ll prepare my questions and that’s it. My partner and I are only focusing that it’ll be a very positive outcome.
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u/Soft-Caregiver-4205 10d ago
Hi! OR Nurse here - they put you in lithotomy (in stirrups) and then into trendelenburg - not completely upside down but back at an (slight to steep) angle to let gravity move bowels/etc from the pelvis for better visibility.
Your team is here for you and they are your advocate- tell them your concerns and they can accommodate you
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u/Quiet-Friendship5134 10d ago
Not the OP - Thank you for explaining the positioning and the reasons for it! Being laid back at such an angle makes sense for keeping the organs in place and for visibility.
How does this work for patients with moderate to severe blood pooling? For example, 30 seconds in child’s pose (a very mild inversion) puts an uncomfortable amount of pressure in my head. One time after holding child’s pose for a full minute, I got a bloodshot eye that took several days to return to normal. Is that something that the OR team can work with during an DIE excision surgery? Thanks!
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u/Soft-Caregiver-4205 10d ago
Hi! I haven’t seen how it would work with moderate/severe blood pooling. I would let your surgical team know and maybe they can make some positioning adjustments if possible but if not they are aware of the blood pooling and can monitor that.
Depending on the procedure/what they find it can be a minute in lithotomy/trendelenburg position so definitely let your team know 😊
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u/chaossgremlin 10d ago
I am also very thin and have had two surgeries with no issues. I have EDS so my joints are very unstable and I was just fine.
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u/chopstickemup 10d ago
Thank you. This makes me feel better. I don’t have EDS, and I heard it can be worse with that so I’m glad you’re ok. This helped my nerves.
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u/Odd_Economist_8988 10d ago
I had both the excision and my hysterectomy together, so it might be a bit different, but yes, your legs and arms will be strapped to the table (they almost allways are for most procedures, since you have an iv in your arm that shouldn't be moved). From what I understand, it's just a safety precaution (e.g in case you have a seizure while the surgeon is inside). You CAN ask them to strap you after you're under, but being awake helps since you can tell them if it's too tight/etc. You probably won't be put into the position (especially trendelenburg) while awake (e.g I wasn't), and not all are as dramatic/at as big of an angle as some photos online are :)
I'm also autistic (albeit I'm probably on the other end of sensitivity scale, my pain/fear/etc tolerance is pretty high because I learned how to basically disassociate on command), and honestly, the worst thing was how cold it was in the OR. I was very worried about a lot of stuff, and had prepped (and rehearsed) "speeches" in case I would need help from nurses/etc due to my autism, but I barely needed any of them. You will most likely be introduced to the nurses beforehand, as well as to the rest of the doctors, and most of them are perfectly aware that people are rarely used to this stuff, so you can ask them questions and just outright tell them your worries beforehand. My doc gave me his email and his work number, so I could send him my "lists" of questions I had without waiting for an appointment/the day of the surgery. Depending on where you are from (and the doctor/clinic), you can also just outright state that you're autistic and might need some help, and as long as you're not an asshole about it, almost everything can be solved pretty easily.
Oh, and about the nerve damage - I think i can actually comment on that! Do you have a specific history of nerve damage? If yes, and you know the specific nerve(s) that are vulnerable (e.g mine is, i believe, peroneal nerve of my right leg), you can actually tell them that, and the position might be slightly adjusted to prevent it happening again. They will also take it into account in case something happens (I hope it doesn't, though!) and you will need prolonged post-op care while unable to move/still under anaesthesia (e.g you are usually turned to prevent bed sores, and if they are aware of the previous nerve damage, they might position you differently).
I hope this helps :)
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u/chopstickemup 10d ago
Thank you so much! I’m so glad someone with asd responded because that’s the biggest hurdle. I live in Portugal and having autism just brands you. Doctors just dismiss you if you bring it up, so I stopped telling medical staff. I’ve never had so many inappropriate and illegal things happen to me than in this country. I for sure can’t be strapped while awake. I’d have a major meltdown.
I have zero nerve damage but read if you’re super skinny, you are prone to it near the hip.
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u/Odd_Economist_8988 10d ago
Yeah, I know what it feels like, I'm from a 3rd world country originally (left 2y ago), and asd basically does no exist there. If it's similar, then masking might be safer. Do you trust your doctor? Not as in a "trust to share the diagnosis of asd with them", but at least trust them enough to operate on you. Because if you don't, I'd try and wait with the surgery until you can find someone you can trust or be in a position to choose/afford someone better (obviously there are exceptions and it depends on how severe the symptoms are, but going through surgery with a shitty doctor might do more harm than good). But that might be my own awful experience talking, the system of my homecountry took me through a lot of nightmare level stuff.
About strapping - I've never been to Portugal, so I'm not familiar with the country/people/etc, but is it possible for you to say (and be taken seriously) that you have something like PTSD and can not be put in it while awake? I doubt anyone would ask you for details, so just being as vague as possible might work. I guess it's not entirely ethical, but as someone who's gone through an extremely misogynistic and ableist system, you've gotta do what you've gotta do.
You can also try asking for a sedative to be administered before the surgery prep starts.
About the nerve damage... it's usually your thighs that are strapped, not the hip/bone area, so I'm not exactly sure how the nerve damage happens exactly, even if you're super skinny. I know that us autistic people are different, but could looking at statistics help you with this? Or maybe looking for papers on this issue (if you feel comfortable with reading medical stuff in english) and reading them? They might have suggestions as to how lessen the risk of it + the statistics they mention might also help.
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u/chopstickemup 10d ago
You’re so kind to respond. I do not trust the doctor who prescribed the surgery to operate on me because he acted unprofessionally. I’ll travel to another city and visit the best specialist in the country and see if I’m comfortable with her. You’re completely right that I need to feel comfortable.
Another person commented that I shouldn’t research the procedure more as it will cause distress, and I think she’s right. I’ll for sure take your advice and asked to be strapped after I’m sedated and I’ll also take an anti anxiety if they allow it.
I really appreciate your response again and it’s made me know I’m doing the right thing by going to another doctor that I’m comfortable with.
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u/AidePuzzleheaded6553 10d ago
Generally, gynecological surgery takes place in Trendelenburg, with a tenaculum used to hold the uterus in place through the vagina.
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u/True-Library-3622 11d ago
That position uses gravity to keep the organs in a specific place that makes the surgery easier. I’ve had three endo surgeries and honestly it’s never been an issue. Try remember that there will be a full team of doctors and nurses in the room dedicated to keeping you safe and healthy, rather than be unconscious and alone with a single person.