Hysterectomy – laparoscopic surgery

(Surgical Removal of the Uterus [or Womb]; Abdominal Hysterectomy)

Hysterectomy – laparoscopic surgery – Definition

Hysterectomy is the surgical term for the removal of the uterus (womb). This results in the inability to become pregnant.

There are different types of surgeries, such as:

• Supracervical hysterectomy — removal of the uterus only
• Total hysterectomy — removal of the uterus and cervix (the opening of the uterus leading to the vagina)
• Radical hysterectomy — removal of the uterus, ovaries, fallopian tubes, upper part of the vagina, and the pelvic lymph nodes
• Salpingo-oophorectomy — removal of the ovaries and fallopian tubes (may be combined with any of the above procedures)

Hysterectomy – laparoscopic surgery – Reasons for Procedure

You may have a hysterectomy if your uterus is causing health problems that cannot be treated by other means. Some reasons a woman may have a hysterectomy are to:

• Treat cancers (eg, uterine, endometrial, ovarian cancers)
• Remove uterine fibroids
• Treat chronic pelvic pain
• Treat heavy bleeding

Explore your options before having a hysterectomy. There are other treatments for many of these problems.

Hysterectomy – laparoscopic surgery – Possible Complications

If you are planning to have hysterectomy, your doctor will review a list of possible complications, which may include:

• Reactions to anesthesia
• Pain
• Infection
• Bleeding
• Fatigue
• Injured pelvic organs (bowel and/or bladder)
• Urinary incontinence (problems controlling your urine)
• Loss of ovarian function and early menopause
• Depression
• Sexual dysfunction

Some factors that may increase the risk of complications include:

• Obesity
• Smoking
• Heart or lung disease
• Diabetes
• Previous pelvic surgery or serious infection
• Use of medicines during the past month

Discuss the risks with your doctor before surgery.

Hysterectomy – laparoscopic surgery – What to Expect

Prior to Procedure

Your doctor may do the following:

• Blood and urine tests
• Pap smear
• X-ray of abdomen and kidneys — a test that uses radiation to take a picture of structures inside the body
• Pelvic ultrasound — a test that uses sound waves to show organs in the abdomen
• Dilation and curettage (D&C) — surgical removal of tissue from the lining of the uterus

You should do the following:

• Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
  • Aspirin or other anti-inflammatory drugs
  • Blood thinners, such as warfarin (Coumadin)
  • Clopidogrel (Plavix)
• Arrange for a ride home and for help at home.
• Eat a light meal the night before the surgery. Do not eat or drink anything after midnight.

Hysterectomy – laparoscopic surgery – Anesthesia

General anesthesia will be used. You will be asleep during the surgery.

Hysterectomy – laparoscopic surgery – Description of the Procedure

You may be given antibiotics just before your surgery.

Laparoscopic procedures are minimally invasive. This means that small incisions are made, rather than the large incisions that are used during open surgery.

Supracervical Hysterectomy

During this procedure, the doctor will make small incisions in the area of your navel and hip bone. A laparoscope (a small tool with a camera on one end) will be inserted through one of the incisions. The tool will allow the doctor to view your pelvic organs on a monitor. Other tools will also be inserted to do the surgery. Next, the doctor will detach the uterus from the cervix. A tool will be used to break down the uterus into smaller pieces. The doctor will then remove this tissue through the small incisions.

Laparoscopic-Assisted Vaginal Hysterectomy

Similar to the above surgery, the doctor will make small incisions in the abdominal area and insert tools. The doctor will then make an incision in the vagina to help detach the lower portion of the cervix and the uterus. The cervix and uterus will then be removed through the vaginal opening.

Robot-Assisted Hysterectomy

A hysterectomy can also be done using robotic technology. Like the laparoscopic procedures, tools are placed through small incisions in the abdominal area. The doctor, though, sits at a console and views the organs via a monitor that displays a 3D image. The surgery is done using a joystick-like device to control the tools.

Hysterectomy – laparoscopic surgery – Immediately After Procedure

You will be given IV fluids and medicines.

Hysterectomy – laparoscopic surgery – How Long Will It Take?

1-3 hours

Hysterectomy – laparoscopic surgery – Will It Hurt?

You will not have pain during the surgery because of the anesthesia. During your recovery time, your doctor will give you pain medicine.

Hysterectomy – laparoscopic surgery – Average Hospital Stay

You may be able to leave the hospital on the same day or the next day. You will stay longer if you have complications.

Hysterectomy – laparoscopic surgery – Post-procedure Care

At the Hospital

While you are recovering at the hospital, you may receive the following care:

• On the first night, the nurse will help you sit up and walk.
• During the next morning, the IV will be removed if you are eating and drinking well.
• You may need to wear special stockings or boots to help prevent blood clots.
• You may have a Foley catheter for a short time to help you urinate.

At Home

During the first few days, you may have pain, bloating, vaginal bleeding, and vaginal discharge.

When at home, take these steps to care for yourself:

• To prevent infection, take proper care of the incision areas.
• Slowly increase your activities. Begin with light chores and short walks.
• During the first two weeks, rest and avoid strenuous activities, like heavy lifting.
• Ask your doctor when it is safe for you to return to work and drive.
• Ask your doctor when you will be able to shower, bathe, or soak in water.
  • Eat a diet rich in fruits and vegetables.
  • Pain medicines can cause constipation. To avoid constipation:
  • Eat high-fiber foods.
• Drink plenty of water.
• Use stool softeners if needed.
• Ask your doctor when you can use tampons.
• Wait six weeks before resuming sexual activity.
• Ask your doctor if you should do Kegel exercises to strengthen the pelvic floor muscles.
• Follow your doctor’s instructions.

Note: If the doctor has not removed your cervix, you will need to continue to have Pap smears to check for cervical cancer.

Hysterectomy – laparoscopic surgery – Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

• Signs of infection, including fever and chills
• Redness, swelling, increasing pain, excessive bleeding, leakage, or any discharge from the incision sites
• Nausea and/or vomiting
• Dizziness or fainting
• Cough, shortness of breath, or chest pain
• Heavy bleeding
• Pain that you cannot control with the medicines you have been given
• Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine
• Swelling, redness, or pain in your leg
• In case of an emergency, call for medical help right away.