Do I have the right to request Laparotomy instead of Laparoscopy to remove a complex septated ovarian cyst?

An ER visit CT for kidney stone showed some other things. My Dr sent me for CT & MRI w/& w/o cont. Results= Complex septated cystic mass 6.5x5.4x3.6cm, R pelvis superior to bladder. Possibly layering debris. Enhancmt of 1 of the septated components, inferomedial aspect, measuring 2.3cm. Slight enhancmt of tissues at base of cyst. L ovary is normal w/sm follicular cysts. Trace fluid adjacent to L ovary. Pelvic calcifications, likely phleboliths. Multiple retroperitoneal lymphnodes, range sub-cm to 1.2cm L of aorta, 1.5x0.8cm L of aorta, 1.4x0.9cm L of the iliac artery.  My Dr referred me to a gyno-oncologist. At consult, he did a TVUS, exam, & scheduled a PET/CT for lymphs. He's going to remove the R ovary & tube, to test. If PET is clear, the surg will be laparoscopic.  Some of my medical history: I have Pseudotumor Cerebri. Thyroid removed for benign nodules. Cholesectomy (laparoscopic). 2 surg to remove benign breast lumps. Myomectomy for fibroids (bikini cut). Hysterectomy-4yrs ago- for fibroids. Cervix, uterus & left tube (also, bikini cut). Kept ovaries for hormones. I'm 44, single & enjoy working. Have always been a strong, independent person. Have a high tolerance for pain, & don't like to lay around, even when sick. Here is what I am seeking your advice on..... [Assuming PET results are clear]  1st: I prefer to have both ovaries removed, instead of just the R, to avoid this again. I realize this will start menopause. Do I have a right to request the other ovary be removed?  2nd: I prefer to have the surgery done as Laparotomy, not Laparoscopy. I realize the risks & recovery time of both. I left a message for the Dr, requesting the surg be laparotomy. His assistant told me Dr said I must come to office to discuss request. Now, I feel like I have to "plead my case before the judge". It's my body, shouldn't I be able to choose? Do I have the right to have the surgery by laparotomy instead?  Thank you for your time and advice.  -Doreen

[Annekathryn Goodman, M.D.]

Dear Doreen,
that is a great question.

I would divide decision on choices into two broad categories:

-choosing among options that are all reasonable and medically and scientifically sound
-choosing to do something that has no scientific or medical  basis (like taking some weird herb or using crystals to try to cure cancer or even taking an FDA approved drug for a non FDA approved reason)

Your decision making and choices fall into category one.

It is perfectly reasonable to only take out one ovary if the cyst is benign but on the other hand, if you decide to take out both ovaries for prevention of cysts or other ovarian diseases , that is completely legitimate. (If you were 25 year, it would not be reasonable).

So I support your decision to remove both ovaries and tubes.

Decisions about surgical approach (vertical incision, transverse incision, laparoscopy , robot) is a technical decision. Usually the surgeon who has the most technical experience and knowledge can guide you about what is surgically reasonable or not.

However, I agree with you! You have had a lot of surgery. It maybe technically eas and safe to remove your ovaries by laparoscopy but it also might be very complicated with the risk of a retained ovarian syndrome.

Personally, I would listen to you. You are very well informed and have decided that laparotomy is more likely to get the job done, albeit with more post op healing time.

good luck and best wishes.