Hysterectomy—Laparoscopic Surgery

Hysterectomy is the surgical term for the removal of the uterus (womb). This results in the inability to become pregnant. The surgery may be done through the abdomen or the vagina.

This type of surgery can be:

• Partial or subtotal hysterectomy—removal of the uterus (without removing the cervix)
• Total, complete, or simple 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)

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 —noncancerous tumors that grow in the muscle of the uterus
• Treat chronic pelvic pain
• Treat heavy bleeding

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

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.

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
• Ask you to use an enema to clean out the intestines (rare)

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)
• If instructed, take antibiotics.
• 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.

Anesthesia

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

Description of the Procedure

Laparoscopically-Assisted Vaginal Hysterectomy (LAVH)

The doctor will make a small cut near the navel to insert a laparoscope (instrument with a camera on the end). This device will allow the doctor to see the pelvic organs. To better view the organs, the abdomen will be inflated with carbon dioxide. The doctor will make more small cuts in the abdomen. Through these cuts, other small tools will be inserted. A cut will also be made where the uterus joins the vagina. The bladder and rectum will be gently pushed off the uterus. The uterus will then be removed through the cut in the vagina. Lastly, the doctor will close the cut with stitches.

LAVH

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A "packing" (sterile gauze) is placed in the vagina. This will be removed after 1-2 days.

In some cases, the doctor may switch to open surgery.

Immediately After Procedure

You will be given IV fluids and medicines.

How Long Will It Take?

1-3 hours

Will It Hurt?

You will likely have pain, fullness, bloating, and vaginal bleeding or discharge during the first few days. Your doctor will give you pain medicine.

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.

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

When at home, do the following:

• Follow your doctor's instructions .
• Take proper care of the incision site. This will help to prevent an infection.
• Ask your doctor about when it is safe to shower, bathe, or soak in water.
• During the first two weeks, rest and avoid lifting.
• Slowly increase your activities. Begin with light chores and short walks. Depending on your job, you may be able to return to work.
• Check with your doctor to see when it is safe to drive again.
• Eat a diet rich in fruits and vegetables. Ask your doctor if you need to take iron.
• Avoid constipation by:
  • Eating high-fiber foods
  • Drinking plenty of water
  • Using stool softeners if needed
• Ask your doctor when you can use tampons. Also ask about Kegel exercises.
• Wait six weeks before resuming sexual activity.
• If you still have a cervix, you will still need regular Pap smears.

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 site
• Incision opens up
• 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.